Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-05-05-29
TL Number from the TL Form:
Sample Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Sample Organization Contact: (559) 793-0903
Type of Sample: Informational
Type of Material: Asphalt Binder
Sample Taken Date: 05/05/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/20/2020
The quantity of what the sample constitutes: Can of Oil
A brief description of the sample: 1 can of PG64-10
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Chowchilla Asphalt Incorporated
Performance Grade: PG 64-10
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2020-05-05-29-1
Test Method: AASHTO T315-16: Standard Method of Test for Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) (Dynamic Shear)
Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Organization Address: 27671 Avenue 120,
Organization City: Porterville
Organization State: CA
Organization Zipcode: 93257
Organization Email: jordanb@jaxonaggregates.com
Organization Phone: (530) 227-0982
Data has not been verified.
