Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214735 DEA: 060Y0904 EFIS: 0619000217
QA Service Level: 1
DIST-CO-RTE-PM: 06-KIN-41-16.1/20.0
Work Description: COLD PLANE AC PAVEMENT AND RESURFACE WITH HMA.
Location Description: KINGS COUNTY IN AND NEAR KETTLEMAN CITY FROM 1.1 MILES NORTH OF BULLWHEEL RIDGE ROAD TO 0.1 MILE SOUTH OF QUAIL AVENUE
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: PO BOX 2210, PISMO BEACH, CA 93448
Resident Engineer: Fernando deAlba Structure Rep.: Unknown
DIME Sample ID: 2020-06-22-18
TL Number from the TL Form: 816153
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 06/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2020
The quantity of what the sample constitutes: 1 Can
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: Sierra Pacific Material-Coalinga
Performance Grade: PG 70-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
