Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215596 DEA: 061C1604 EFIS: 0621000103
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD,MAD-99-1.5/7.4
Work Description: Remove and replace failed pavement on the number 2 lane on both the N and S directions.
Location Description:
Contractor Name: CHRISP COMPANY
Contractor Address: 1001 Stokes Avenue, Stockton, CA 95213
Resident Engineer: FELIX VAQUILAR Structure Rep.: Unknown
DIME Sample ID: 2021-05-17-22
TL Number from the TL Form: c039618
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 05/17/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/26/2021
The quantity of what the sample constitutes: 1 of 1 can
A brief description of the sample: PG64-16
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials - Madera
Performance Grade: PG 64-16
Modified: No
Lot number: 1
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Vulcan Materials - Madera
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
