Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215412 DEA: 061A9404 EFIS: 0620000141
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-20.0/21.0,30.9/37.3
Work Description: COLD PLANE AND REPLACE WITH RHMA (TYPE O).
Location Description: FRESNO COUNTY FROM 2 MILES NORTH OF ROUTE 5/33/145 SEPARATION TO SOUTH DERRIC AVENUE OVERCROSSING AND FROM 1 MILE NORTH OF ROUTE 5/33 SEPARATION TO 1.1 MILES SOUTH OF KAMM AVENUE OVERCROSSING
Contractor Name: Austin Enterprise
Contractor Address: Box 81926, Bakersfield, CA 93380
Resident Engineer: Din Dadawalla Structure Rep.: Unknown
DIME Sample ID: 2021-06-15-41
TL Number from the TL Form: 040436
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: Asphalt Binder, NO test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refining Co Inc
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
