Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214605 DEA: 051K7904 EFIS: 0519000026
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-166-R51.1/55.0
Work Description: COLD IN-PLACE RECYCLING AND RHMA OVERLAY.
Location Description: SANTA BARBARA COUNTY ABOUT 10 MILES WEST OF NEW CUYAMA FROM CUYAMA RIVER BRIDGE TO 3.1 MILES EAST OF COTTONWOOD CANYON ROAD
Contractor Name: Calportland Construction
Contractor Address: 1625 East Donovan Rd, Santa Maria, CA 93454
Resident Engineer: Thomas Petersen Structure Rep.: Unknown
DIME Sample ID: 2020-09-10-10
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 Rubber Binder
Sample Taken Date: 09/10/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/15/2020
The quantity of what the sample constitutes: One JMF Renewal
A brief description of the sample: Quart Can ARB
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: National Blending Company
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
