Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2021-02-04-3
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: 02/04/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/04/2021
The quantity of what the sample constitutes: 1 can
A brief description of the sample: Aspalt Binder PG64-10/16
From where was the sample collected: Manufacturer
Laboratory sample identification: 123345
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refining Co Inc
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number: 3
Time of sample: 8:00am
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2021-02-04-3-1
Test Method: AASHTO T240-17: Standard Method of Test for Effect of Heat and Air on a Moving Film of Asphalt Binder (Rolling Thin-Film Oven Test)
Submitted By Organization: Veleroo - Coolidge
Organization Address: 123 Abc Street,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email: binderlab1@gmail.com
Organization Phone: (111) 111-1111
Data has not been verified.
DIME Test ID: 2021-02-04-3-2
Test Method: AASHTO T51-13: Standard Method of Test for Ductility of Asphalt Materials (Asphalt Binder)
Submitted By Organization: Veleroo - Coolidge
Organization Address: 123 Abc Street,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email: binderlab1@gmail.com
Organization Phone: (111) 111-1111
Data has not been verified.
DIME Test ID: 2021-02-04-3-3
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: Veleroo - Coolidge
Organization Address: 123 Abc Street,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email: binderlab1@gmail.com
Organization Phone: (111) 111-1111
Data has not been verified.
DIME Test ID: 2021-02-04-3-4
Test Method: AASHTO T313-19: Standard Method of Test for Determining the Flexural Creep Stiffness of Asphalt Binder Using the Bending Beam Rheometer (BBR)
Submitted By Organization: Veleroo - Coolidge
Organization Address: 123 Abc Street,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email: binderlab1@gmail.com
Organization Phone: (111) 111-1111
Data has not been verified.
