*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Sample Record for 2020-07-24-19


Project Information

Project ID: 214731 DEA: 051M0004 EFIS: 0519000047 QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-101-16.5/R21.5
Work Description: COLD PLANE AND RHMA-GAP GRADED OVERLAY ON EXISTING ROADWAY.
Location Description: SAN LUIS OBISPO COUNTY IN AND NEAR PISMO BEACH FROM 0.1 MILE SOUTH OF PRICE CANYON ROAD TO SAN LUIS CREEK BRIDGE
Contractor Name: PAPICH CONSTRUCTION CO. INC. Contractor Address: 398 SUNRISE TERRACE
Resident Engineer: Lilian Bennetzen Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-07-24-19
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Field Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Verification
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 07/24/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: One JMF Verification
A brief description of the sample: Quart can of ARB
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number: