Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212741 DEA: 020E1804 EFIS: 0200000022
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-89-29.8/30.2
Work Description: BRIDGE REPLACEMENT
Location Description: PLUMAS COUNTY NEAR CANYON DAM FROM 0.2 MILE SOUTH TO 0.3 MILE NORTH OF LAKE ALMANOR SPILLWAY
Contractor Name: Q&D CONSTRUCTION, INC.
Contractor Address: P.O Box 10865, Reno, NV 89510
Resident Engineer: Ryan Johnson Structure Rep.: Matt Crete
DIME Sample ID: 2018-06-04-36
TL Number from the TL Form: 894777
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 06/04/2018
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2018
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: Asphalt Binder
From where was the sample collected: Manufacturer
Laboratory sample identification: D77438
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina Asphalt - Klamath FAlls, OR
Performance Grade: PG 64-28 M
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2018-06-04-36-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 01/22/2019
Date Tested: 04/04/2018
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: 530-225-3194
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
