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Sample Record for 2020-12-17-1

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 99999 DEA: 0322222 QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-12-17-1
TL Number from the TL Form:
Sample Submitted By Organization: Veleroo - Coolidge
Sample Organization Contact: 111-111-1111
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 12/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 12/17/2020
The quantity of what the sample constitutes: 1
A brief description of the sample: Split sample 1a
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: kjhkljh

Material Information

Performance Grade: PG 58-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Asphalt Binder Supplier:
Multigrade:
Multigrade Type:

Test Results

Test 1 of 2

DIME Test ID: 2020-12-17-1-1
Test Method: AASHTO T201-15: Standard Method of Test for Kinematic Viscosity of Asphalts (Bitumens) (Residue from RTFO)
Verified Date: 12/17/2020
Date Tested: 12/17/2020
Submitted By Organization: Veleroo - Coolidge
Organization Address: 123 Abc St,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email:
Organization Phone: 111-111-1111
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Test Result Value 546541

Test 2 of 2

DIME Test ID: 2020-12-17-1-2
Test Method: AASHTO T201-15: Standard Method of Test for Kinematic Viscosity of Asphalts (Bitumens) (Residue from RTFO)
Verified Date: 12/17/2020
Date Tested: 12/17/2020
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (916) 227-7302
General Comments for this Test: sample 1b
Test Result Compliance: complies
Additional Comments When Verified:
Test Result Value 41545

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.