Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215251 DEA: 021J4604 EFIS: 0220000081
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-34.5/38.8,88.0/92.0
Work Description: HMA OVERLAY, REPLACE AC SURFACING, SHOULDER BACKING & TRAFFIC STRIPE.
Location Description: SISKIYOU COUNTY NEAR HAPPY CAMP FROM 0.1 MILE EAST OF OAK FLAT CREEK BRIDGE TO 0.1 MILE EAST OF BENJAMIN CREEK ROAD AND FROM 0.3 MILE WEST OF BEAVER CREEK BRIDGE TO 1.0 MILE WEST OF LUMGREY CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2021-06-07-20
TL Number from the TL Form: 779371
Sample Submitted By Organization: CT D02 - North Region Materials Lab
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 06/07/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/08/2021
The quantity of what the sample constitutes: 150 Tons
A brief description of the sample: PSE 1/2 Cold feed
From where was the sample collected: Manufacturer
Laboratory sample identification: D78835
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Inc, Northstate Asphalt, Redding CA
Source Identification (SMARA or name of Pit): 91-45-0057
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Samplimg Device at Plant
Where the material sample would have been placed if not sampled: 02 SIS 96
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number: Unknown
Sublot number: Unknown
DIME Test ID: 2021-06-07-20-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D02 - North Region Materials Lab
Organization Address: 1657 Riverside Dr,MS-83
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: (530) 225-3194
Data has not been verified.