Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214426 DEA: 030A5704 EFIS: 0300020593
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB-20-13.3/R18.2
Work Description: Browns Valley Rehab: CONSTRUCT BRIDGE, REALIGN CURVE, WIDEN SHOULDERS AND CULVERT WORK.
Location Description: YUBA COUNTY FROM MARYSVILLE ROAD TO THE YUBA RIVER BRIDGE
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 400 Sunrise Ave, Suite 300, Roseville, CA 95661
Resident Engineer: Garrett Griffith Structure Rep.: Matt Crete
DIME Sample ID: 2021-04-01-41
TL Number from the TL Form: C706329
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: 04/01/2021
Date that the sample was received by the laboratory/organization performing the testing: 04/01/2021
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: PG 64-16 Marathon
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF21-020C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert - Hallwood Plant
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Elk Grove CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
