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: 2020-04-23-22
TL Number from the TL Form: 899094
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 04/23/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/26/2020
The quantity of what the sample constitutes: 4 cans
A brief description of the sample: PG 64-16 Asphalt Binder #1 test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: National Blending Company
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:
