Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2019-11-15-15
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Control
Type of Material: Warm Mix Asphalt Technology
Sample Taken Date: 11/15/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2019
The quantity of what the sample constitutes: JMF Submittal
A brief description of the sample: Warm Mix Asphalt Technology - Evotherm M1
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity
Warm Mix Asphalt Technology Type: Additive Technology
Warm Mix Asphalt Technology Product Name: Evotherm M1
WMA Mix Number:
