Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 44444 DEA: ASCP EFIS: ASCP
QA Service Level:
DIST-CO-RTE-PM: 59---
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
DIME Sample ID: 2021-03-30-6
TL Number from the TL Form:
Sample Submitted By Organization: Valero-NuStar PAT - Pittsburg
Sample Organization Contact: (707) 745-7089
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 03/30/2021
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 Sample
From where was the sample collected: Manufacturer
Laboratory sample identification: 70-10-303021
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Pittsburg
Performance Grade: PG 70-10
Modified: No
Lot number:
Sublot number:
Tank number: 5
Time of sample: 7am
HMA Supplier:
Certified Asphalt Supplier: Valero-NuStar PAT - Pittsburg CA
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2021-03-30-6-1
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)
Submitted By Organization: Valero-NuStar PAT - Pittsburg
Organization Address: 1100 Willow Pass Road,
Organization City: Pittsburg
Organization State: CA
Organization Zipcode: 94565
Organization Email: patrick.sendegeya@valero.com
Organization Phone: (707) 745-7214
Data has not been verified.
