Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214555 DEA: 020J1204 EFIS: 0219000063
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-89-7.0/14.0
Work Description: HMA OVERLAY WITH REPLACE CONCRETE ASPHALT SURFACING, SHOULDER BACKING.
Location Description: SISKIYOU COUNTY AT AND NEAR BARTLE FROM 2.4 MILES NORTH OF BARTLE GAP ROAD TO 0.3 MILE SOUTH OF MILITARY PASS ROAD
Contractor Name: J F SHEA CONSTRUCTION INC
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2020-07-23-28
TL Number from the TL Form: 990673
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: 07/23/2020
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 NO TEST (990673)
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:
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Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
