Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215307 DEA: 033F5004 EFIS: 0313000019
QA Service Level: 1
DIST-CO-RTE-PM: 03-GLE-5-R7.4/R17.0
Work Description: PLACE HMA (TYPE A) AND MODIFY INTERCONNECTION CONDUIT AND CABLE.
Location Description: GLENN COUNTY IN AND NEAR WILLOWS AT VARIOUS LOCATIONS FROM COUNTY ROAD 57 OVERCROSSING TO COUNTY ROAD 33 OVERCROSSING
Contractor Name: BALDWIN CONTRACTING COMPANY, INC. DBA KNIFE RIVER CONSTRUCT
Contractor Address: 1764 Skyway, CHICO, CA 95928
Resident Engineer: Tony Granados Structure Rep.: Unknown
DIME Sample ID: 2021-03-12-20
TL Number from the TL Form: C778174
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: 03/12/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/12/2021
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: PG 64-16
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF21-003
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Knife River Construction - Orland Drum Plant
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
