Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215405 DEA: 032G1604 EFIS: 0320000235
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-45-0.6/12.9
Work Description: COLD PLANE AC PAVEMENT AND REPLACE WITH HOT MIX ASPHALT.
Location Description: YOLO COUNTY NEAR KNIGHTS LANDING FROM SYCAMORE SLOUGH BRIDGE TO YOLO COUNTY LINE ROAD
Contractor Name: All American Asphalt
Contractor Address: PO Box 635, Live Oaks, CA 95953
Resident Engineer: Luis Pompa Structure Rep.: Unknown
DIME Sample ID: 2021-03-19-26
TL Number from the TL Form: C849138
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: 03/19/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/19/2021
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: Asphalt Binder PG 64-16
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF21-015
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert - Woodland Plant
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Teichert - Woodland Plant
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Elk Grove CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
