Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214618 DEA: 033F99U4 EFIS: 0319000311
QA Service Level: 1
DIST-CO-RTE-PM: 03-SUT-99-39.2/41.4
Work Description: WIDEN RDWY, HMA, CRCP, WATER LINE, SIGNALS, & LIGHTING SYSTEM.
Location Description: SUTTER COUNTY IN AND NEAR LIVE OAK FROM 0.1 MILE SOUTH OF COLEMAN AVENUE TO NEVADA STREET (NORTH INTERSECTION)
Contractor Name: DESILVA GATES CONSTRUCTION
Contractor Address: 3855 N Freeway Blvd. , Ste 105, Sacramento, CA 95834
Resident Engineer: Dwayne Grandy Structure Rep.: Unknown
DIME Sample ID: 2020-07-23-51
TL Number from the TL Form: C723296
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 07/23/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/24/2020
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: PG-58-22, Valero
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF20-032
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates Aggregates-Marysville
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
