Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214691 DEA: 060Y0804 EFIS: 0619000242
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R0.0/M6.1
Work Description: COLD PLANE AC PAVEMENT, HMA (TYPE A) & RHMA-GAP GRADED (BWC) OVERLAY.
Location Description: FRESNO COUNTY NEAR LEMOORE FROM EXCELSIOR AVENUE TO ELKHORN AVENUE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 2716 Granite Court, Fresno, CA 93706
Resident Engineer: Donald Hiura Structure Rep.: Unknown
DIME Sample ID: 2020-06-30-35
TL Number from the TL Form: 027506
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Rubber 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 each sample,#4(027506), #5(027510), #6(027512)
A brief description of the sample: Rubber Binder PG-64-16
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
