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Sample Record for 2021-03-15-18

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

Project Information

Project ID: 214492 DEA: 033F5404 EFIS: 0313000136 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99,160-4.5/5.7,R44.5
Work Description: FURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE.
Location Description: SACRAMENTO COUNTY NEAR GALT ON ROUTE 99 FROM NORTH OF MINGO ROAD TO SOUTH OF ARNO ROAD OVERCROSSING AND IN SACRAMENTO ON ROUTE 160 AT AMERICAN RIVER BRIDGE
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 5000 Marsh Drive, Suite 300, Conord, CA 94520
Resident Engineer: Mohssen Ghassemi Structure Rep.: Chris Quon

Sample Information

DIME Sample ID: 2021-03-15-18
TL Number from the TL Form: C849136
Sample Submitted By Organization: CT D03 - North Region Materials Lab
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 03/15/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/15/2021
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: PG 64-16 Asphalt Binder
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF21-012
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins Batch Plant

Material Information

Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Asphalt Binder Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.