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: 2021-04-06-48
TL Number from the TL Form:
Sample Submitted By Organization: RJ Noble Company
Sample Organization Contact: (714) 235-7028
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 04/06/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/06/2021
The quantity of what the sample constitutes: 4 CANS 64-28M
A brief description of the sample: 4 CANS OF 64-28M
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Refining-marathon bakersfield
Performance Grade: PG 64-28 M
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:
DIME Test ID: 2021-04-06-48-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 04/28/2021
Date Tested: 04/06/2021
Submitted By Organization: RJ Noble Company
Organization Address: 15505 East Lincoln Avenue, P.O. BOX 620
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: qualitycontrol@rjnoblecompany.com
Organization Phone: (714) 235-7028
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
