Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214293 DEA: 060S4604 EFIS: 0615000038
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-99-R0.9/R5.0
Work Description: REPLACE CONCRETE AND ASPHALT PAVEMENT.
Location Description: FRESNO COUNTY IN AND NEAR KINGSBURG AND SELMA FROM ROUTE 99/201 SEPARATION TO 0.3 MILE SOUTH OF SECOND STREET UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38155 Monroe Street, Indio, CA 92203
Resident Engineer: Mohammad Samimi Structure Rep.: Peter Moua
DIME Sample ID: 2021-03-17-18
TL Number from the TL Form: 040160
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 03/17/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/25/2021
The quantity of what the sample constitutes: 1 of 1 can
A brief description of the sample: Asphalt Binder NO TEST
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refining Co Inc
Performance Grade: PG 64-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
