Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215092 DEA: 101C0404 EFIS: 1017000034
QA Service Level: 1
DIST-CO-RTE-PM: 10-MPA-49-0.3/18.5
Work Description: COLD PLANE, PLACE HMA AND REPLACE RAILING AND OVERSIDE DRAINS.
Location Description: MARIPOSA COUNTY IN AND NEAR MARIPOSA FROM MADERA COUNTY LINE TO SOUTH JUNCTION ROUTE 140
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 400 Sunrise Ave Ste 300,, Roseville, CA 95661
Resident Engineer: Stan Oshita Structure Rep.: Unknown
DIME Sample ID: 2021-06-15-29
TL Number from the TL Form: 030997
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: 06/15/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/21/2021
The quantity of what the sample constitutes: 1 of 1 can
A brief description of the sample: NON TESTED ASPHALT BINDER
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: MARATHON ELK GROVE
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Teichert - Santa Fe Winton
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Elk Grove CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
