Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214844 DEA: 060Y0704 EFIS: 0619000150
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-155-49.5/R60.0
Work Description: PLACE HMA (TYPE A).
Location Description: KERN COUNTY NEAR GLENNVILLE FROM 2.4 MILES EAST OF SANDY CREEK FIRE ROAD TO 0.1 MILE WEST OF ADAMS ROAD
Contractor Name: GRIFFITH COMPANY
Contractor Address: 1128 CARRIER PARKWAY AVENUE;, BAKERSFIELD CA 93308
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-07-06-28
TL Number from the TL Form: 771791
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: 07/06/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2020
The quantity of what the sample constitutes: 1 Can, #2 NO test (771791)
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: San Joaquin Refinery
Performance Grade: PG 64-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
