Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214587 DEA: 101J1604 EFIS: 1018000180
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-132-27.9/41.0
Work Description: COLD PLANE AC PAVEMENT, RHMA OVERLAY AND SLURRY SEAL.
Location Description: STANISLAUS COUNTY IN AND NEAR WATERFORD FROM G STREET TO 1.2 MILES EAST OF RUSHING ROAD
Contractor Name: George Reed
Contractor Address: PO Box, Greenwood, CA 95635
Resident Engineer: Ranbir Bhullar Structure Rep.: Unknown
DIME Sample ID: 2020-05-11-29
TL Number from the TL Form: 034614
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 05/11/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/27/2020
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: PG 64-10 Asphalt Binder #1 Test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Refining
Performance Grade: PG 64-10
Modified: No
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Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
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Asphalt Binder Mix Number:
