Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210618 DEA: 06342534 EFIS: 0600000382 COOP: 061616A2
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-180-R74.1/R78.6
Work Description: CONSTRUCT SEGMENT 3 OF KINGS CANYON EXPRESSWAY
Location Description: FRESNO COUNTY ABOUT 8.4 MILES EAST OF FRESNO FROM 0.7 MILE WEST OF SMITH AVENUE TO 0.7 MILE EAST OF FRANKWOOD AVENUE
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Justin Kimura Structure Rep.: Michael Trinh
DIME Sample ID: 2020-07-24-21
TL Number from the TL Form: 057032
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: 07/24/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2020
The quantity of what the sample constitutes: 1 can, #5 NO TEST (057032), #6(040230)
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 Refining Co Inc
Performance Grade: PG 70-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
