Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214136 DEA: 010F3604 EFIS: 0115000115
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-R39.2/R48.3
Work Description: COLD PLANE AC PAVEMENT, RHMA OVERLAY, AND GUARDRAIL INSTALLATION.
Location Description: HUMBOLDT COUNTY NEAR REDCREST, PEPPERWOOD, AND STAFFORD FROM ENGLWOOD PARK UNDERCROSSING TO EEL RIVER BRIDGE AND OVERHEAD
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO BOX 1006, EUREKA CA 95502
Resident Engineer: Joaquin Rodriguez Structure Rep.: Unknown
DIME Sample ID: 2019-10-29-24
TL Number from the TL Form:
Sample Submitted By Organization: Trinity Engineering Laboratories, Incorporated - Fresno
Sample Organization Contact: (559) 292-2188
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 10/29/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/29/2019
The quantity of what the sample constitutes: RHMA
A brief description of the sample: 1/2 RHMA WMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer Fraser B
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
