Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214618 DEA: 033F99U4 EFIS: 0319000311
QA Service Level: 1
DIST-CO-RTE-PM: 03-SUT-99-39.2/41.4
Work Description: WIDEN RDWY, HMA, CRCP, WATER LINE, SIGNALS, & LIGHTING SYSTEM.
Location Description: SUTTER COUNTY IN AND NEAR LIVE OAK FROM 0.1 MILE SOUTH OF COLEMAN AVENUE TO NEVADA STREET (NORTH INTERSECTION)
Contractor Name: DESILVA GATES CONSTRUCTION
Contractor Address: 3855 N Freeway Blvd. , Ste 105, Sacramento, CA 95834
Resident Engineer: Dwayne Grandy Structure Rep.: Unknown
DIME Sample ID: 2021-06-01-31
TL Number from the TL Form: 706333
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: 06/01/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/21/2021
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: 2ND NO TEST
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero Benicia
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: DeSilva Gates
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
