Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2020-07-10-3
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: Asphalt Rubber Binder
Sample Taken Date: 07/10/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/10/2020
The quantity of what the sample constitutes: test
A brief description of the sample: test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: test
Asphalt modifier supplier: Unknown
Performance Grade: PG 58-22
Lot number: 1
Sublot number: 1
Asphalt Rubber Binder Mix Number:
DIME Test ID: 2020-07-10-3-1
Test Method: ASTM D217-16: Standard Test Methods for Cone Penetration of Lubricating Grease (Cone Penetration)
Verified Date: 08/17/2022
Date Tested: 08/06/2022
Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Organization Address: 5900 Folsom Boulevard, Room 225,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (916) 227-7302
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Determination
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Worked Penetration
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Worked Penetration
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1 0.1 mm
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