Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214726 DEA: 024H3304 EFIS: 0218000108
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-3-31.8/32.1
Work Description: PLACE HMA (TYPE A) FOR TURN LANE & CORRUGATED STEEL PIPE FOR DRAINAGE.
Location Description: TRINITY COUNTY NEAR WEAVERVILLE FROM FIVE CENT GULCH STREET TO 0.5 MILE SOUTH OF EAST WEAVER CREEK ROAD
Contractor Name: Tulis, Inc.
Contractor Address: P.O. Box 493416, Redding, CA 96049
Resident Engineer: Mandhir Grewal Structure Rep.: Unknown
DIME Sample ID: 2020-07-15-49
TL Number from the TL Form: 002340
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: 07/15/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2020
The quantity of what the sample constitutes: 1 Can, #2 NO Test (002340),#3(unknown), #4(unknown)
A brief description of the sample: Asphalt Binder PG 58-34M
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 58-34 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
