Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214756 DEA: 050N7AU4 EFIS: 0520000030
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-1.4/4.8
Work Description: Segment 4A - Carpinteria: Construct HOV lanes and rehabilitation. Source inspection of sign structure trusses, lighting structures, epoxy coated rebar, precast box culverts, precast RCP.
Location Description: CARPINTERIA FROM 0.2 MILE SOUTH OF BAILARD AVENUE OVERCROSSING TO 0.7 MILE SOUTH OF SOUTH PADARO LANE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Rd, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Bernardo Hernandez
DIME Sample ID: 2020-08-19-26
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 08/19/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2020
The quantity of what the sample constitutes: One JMF Verification
A brief description of the sample: One Quart Can Binder
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
