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Sample Record for 2021-03-23-4

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

Project Information

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

Sample Information

DIME Sample ID: 2021-03-23-4
TL Number from the TL Form: 11
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: 03/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/23/2021
The quantity of what the sample constitutes: 1
A brief description of the sample: 1
From where was the sample collected: Source
Laboratory sample identification: 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: 1

Material Information

Performance Grade: PG 58-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Elk Grove CA
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:

Test Results