Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213074 DEA: 044G8904 EFIS: 0413000059
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-580-5.8
Work Description: BIDGE SEISMIC RETROFIT
Location Description: CONTRA COSTA COUNTY IN RICHMOND AT SCOFIELD AVENUE UNDERCROSSING
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 1777 Oakland Blvd., Suite 300, Walnut Creek, CA 94596
Resident Engineer: Jason Trinh Structure Rep.: Eric Urmeneta
DIME Sample ID: 2019-03-14-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 03/14/2019
Date that the sample was received by the laboratory/organization performing the testing: 03/15/2019
The quantity of what the sample constitutes: Asphalt Binder
A brief description of the sample: Asphalt Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Syar Lake Herman
Performance Grade: PG 64-16
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: 2019-03-14-9-1
Test Method: AASHTO T201-15: Standard Method of Test for Kinematic Viscosity of Asphalts (Bitumens) (Residue from RTFO)
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.
