Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210618 DEA: 06342534 EFIS: 0600000382 COOP: 061616A2
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-180-R74.1/R78.6
Work Description: CONSTRUCT SEGMENT 3 OF KINGS CANYON EXPRESSWAY
Location Description: FRESNO COUNTY ABOUT 8.4 MILES EAST OF FRESNO FROM 0.7 MILE WEST OF SMITH AVENUE TO 0.7 MILE EAST OF FRANKWOOD AVENUE
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Justin Kimura Structure Rep.: Michael Trinh
DIME Sample ID: 2020-01-24-16
TL Number from the TL Form: 732467
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 01/24/2020
Date that the sample was received by the laboratory/organization performing the testing: 02/05/2020
The quantity of what the sample constitutes: One Jar
A brief description of the sample: Tack Coat
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Talley Oil
