Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-07-20-41
TL Number from the TL Form:
Sample Submitted By Organization: RJ Noble Company
Sample Organization Contact: (714) 235-7028
Type of Sample: Aggregate Prequalification Program
Type of Material: Asphalt Binder
Sample Taken Date: 07/20/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/20/2020
The quantity of what the sample constitutes: 3 Bags
A brief description of the sample: 3/4 HMA ASPW
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Corona
Performance Grade: PG 64-28
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
