Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213949 DEA: 093494U4 EFIS: 0919000010
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-88.4/91.6,93.4/95.7
Work Description: CONSTRUCT SHOULDER WIDENING, DRAINAGE, AND RETAINING WALLS.
Location Description: MONO COUNTY NEAR SONORA JUNCTION FROM 0.3 MILE NORTH OF DEVILS GATE SUMMIT TO BURCHAM FLAT ROAD AND FROM 0.3 MILE SOUTH OF ROUTE 108 TO 2.0 MILES NORTH OF ROUTE 108
Contractor Name: ROAD AND HIGHWAY BUILDERS OF CALIFORNIA, INC.
Contractor Address: P.O. BOX 70846, Reno, NV 89570
Resident Engineer: Scotese Lee Structure Rep.: Unknown
DIME Sample ID: 2019-08-19-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 08/19/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Plant Tank
A brief description of the sample: Binder Oil
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bing
Performance Grade: PG58-34M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
