Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215253 DEA: 021J4804 EFIS: 0220000083
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA,TRI-36-8.0/11.912,27.1/R41.139
Work Description: ASPHALT RUBBER CHIP SEAL AND TRAFFIC STRIPE.
Location Description: SHASTA AND TRINITY COUNTIES AT AND NEAR PLATINA FROM 0.4 MILE EAST OF MIDDLE FORK COTTONWOOD CREEK BRIDGE TO BEEGUM CREEK BRIDGE AND FROM 1.3 MILES EAST OF BRAMLET ROAD TO SHASTA COUNTY LINE
Contractor Name: NORTHWEST PAVING, INC
Contractor Address: 8115 SECLUDED VALLEY DRIVE;, REDDING CA 96001
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2021-05-26-44
TL Number from the TL Form: Not Provided
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: 05/26/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/23/2021
The quantity of what the sample constitutes: 3RD NO TEST
A brief description of the sample: PG58-22
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero-Benicia Asphalt Plant
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
