Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214571 DEA: 020J1104 EFIS: 0219000062
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-70-33.1/42.1
Work Description: PLACE HMA & SHOULDER BACKING, & REMOVE & REPLACE PAVEMENT DELINEATION.
Location Description: PLUMAS COUNTY AT AND NEAR KEDDIE FROM INDIAN CREEK BRIDGE TO 0.3 MILE WEST OF SPANISH CREEK BRIDGE NO. 09-0018
Contractor Name: Dig It Construction
Contractor Address: 803 Lorraine Dr, P.O. Box 494, Chester, CA 96020
Resident Engineer: Jeff Steppat Structure Rep.: Unknown
DIME Sample ID: 2020-07-22-27
TL Number from the TL Form: 896808
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: 07/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/31/2020
The quantity of what the sample constitutes: 1 Can, #2, #3(896928), #4(896929), #5(896930), #6(unknown), #7(unknown), #8(unknown) NO TEST
A brief description of the sample: Modified Asphalt Binder PG 64-28M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina
Performance Grade: PG 64-28 M
Modified: Yes
Lot number:
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Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
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Asphalt Binder Mix Number:
