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Sample Record for 2021-03-29-4

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

Project Information

Project ID: 44444 DEA: ASCP EFIS: ASCP QA Service Level:
Work Description: Special project for submitting Sample information for Asphalt Supplier Certification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-03-29-4
TL Number from the TL Form:
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: 03/29/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/30/2021
The quantity of what the sample constitutes: 1 of 2, split sample
A brief description of the sample: Asphalt Binder
From where was the sample collected: Manufacturer
Laboratory sample identification: 7010033021
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery

Material Information

Performance Grade: PG 70-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade Type:
Asphalt Binder Mix Number:

Test Results

Test 1 of 1

DIME Test ID: 2021-03-29-4-1
Test Method: AASHTO T240-17: Standard Method of Test for Effect of Heat and Air on a Moving Film of Asphalt Binder (Rolling Thin-Film Oven Test)
Verified Date: 03/30/2021
Date Tested: 03/30/2021
Submitted By Organization: Veleroo - Coolidge
Organization Address: 123 Abc Street,
Organization City: Coolidge
Organization State: AZ
Organization Zipcode: 88888
Organization Email:
Organization Phone: (111) 111-1111
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Is mass change based on one or two containers? Two
Average mass change -0.019 percent