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Sample Record for 2021-06-18-13

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212777 DEA: 021H1104 EFIS: 0215000106 QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-299-25.58/25.58
Work Description: BUILDING WORK.
Location Description: LASSEN COUNTY ABOUT 11 MILES EAST OF BIEBER AT THE ADIN MAINTENANCE STATION
Contractor Name: Walsh Construction Company II, LLC (Walsh)
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Mike Zdenek Structure Rep.: Chris Brace

Sample Information

DIME Sample ID: 2021-06-18-13
TL Number from the TL Form: c766445
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: 06/18/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/24/2021
The quantity of what the sample constitutes: 2 cans
A brief description of the sample: PG 64-28M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina - Klamath Falls, OR

Material Information

Performance Grade: PG 64-28 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Albina Asphalt - Klamath Falls Plant - Klamath Falls OR
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:

Test Results