Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214685 DEA: 024E46U4 EFIS: 0216000122
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-36-6.0/14.6
Work Description: REPLACE BRIDGE, ROADWAY EXCAVATION, HMA, CLASS 2 AB AND DRAINAGE WORK.
Location Description: LASSEN COUNTY NEAR WESTWOOD FROM 1.3 MILES WEST OF GOODRICH CREEK BRIDGE TO 1.0 MILE WEST OF WILLARD CREEK ROAD
Contractor Name: Hat Creek Construction
Contractor Address: 24339 Highway 89 N, Burney, CA 96013
Resident Engineer: Tim Crosby Structure Rep.: Jeff Rothgery
DIME Sample ID: 2020-10-06-38
TL Number from the TL Form: 896942
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Informational
Type of Material: Asphalt Binder
Sample Taken Date: 10/06/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2020
The quantity of what the sample constitutes: Test for MSCR study
A brief description of the sample: PG58-34M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
Performance Grade: PG 58-34 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
