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Sample Record for 2021-02-02-19

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

Project Information

DEA: No Project QA Service Level:
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-02-02-19
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Control
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 02/02/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/01/2021
The quantity of what the sample constitutes: 1
A brief description of the sample: 1
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: 1

Material Information

Asphalt modifier supplier:
Performance Grade: PG 58-22
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:

Test Results