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: 2019-03-12-3
TL Number from the TL Form:
Sample Submitted By Organization: Granite Construction Company - Coastal
Sample Organization Contact: (408) 327-7023
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 03/12/2019
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2019
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: Asphalt Binder Sample
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero-Benicia Asphalt Plant
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: 2019-03-12-3-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 02/05/2021
Date Tested: 03/12/2019
Submitted By Organization: Granite Construction Company - Coastal
Organization Address: 715 Comstock Street,
Organization City: Santa Clara
Organization State: CA
Organization Zipcode: 95054
Organization Email: ryan.gibbs@gcinc.com
Organization Phone: (408) 327-7023
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
