Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 55555 DEA: AMRL EFIS: AMRL
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for AASHTO Materials Reference Laboratory (AMRL).
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-11-25-8
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Proficiency
Type of Material: Asphalt Binder
Sample Taken Date: 11/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/05/2021
The quantity of what the sample constitutes: 1 can, Due JAN 25
A brief description of the sample: Asphalt Binder OREGON COOP
From where was the sample collected: Manufacturer
Laboratory sample identification: 309
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: McCall Oli and Chemical Corp
Performance Grade: PG 64-28
Modified: No
Lot number:
Sublot number:
Tank number: PG 64-22
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
