Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214528 DEA: 024G5404 EFIS: 0214000024
QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-36-40.3/42.1
Work Description: PLACE HMA AND MINOR CONCRETE, AND MODIFY ELECTRICAL SYSTEM.
Location Description: TEHAMA COUNTY IN RED BLUFF FROM 0.6 MILE EAST OF BAKER ROAD TO 0.2 MILE EAST OF EAST SAND SLOUGH BRIDGE
Contractor Name: TULLIS INC
Contractor Address: P O BOX 493416, REDDING, CA 96002-3416
Resident Engineer: Mike Zdenek Structure Rep.: Unknown
DIME Sample ID: 2020-06-30-34
TL Number from the TL Form: 853434
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: 06/30/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/14/2020
The quantity of what the sample constitutes: 1 can, NO Test #2 (583434)
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: Valero - Benicia
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:
