Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214917 DEA: 010J5204 EFIS: 0119000048
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20-33.6/34.6
Work Description: COLD PLANE AC PAVEMENT AND PLACE HMA (TYPE A).
Location Description: MENDOCINO COUNTY IN WILLITS FROM BAECHTEL CREEK BRIDGE TO MONICA LANE
Contractor Name: ARGONAUT CONSTRUCTORS
Contractor Address: PO BOX;, SANTA ROSA CA 95402
Resident Engineer: Nash Munes Structure Rep.: Unknown
DIME Sample ID: 2020-09-02-16
TL Number from the TL Form: 759144
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/02/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/02/2020
The quantity of what the sample constitutes: 1 gallon
A brief description of the sample: Tack coat
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
