Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215251 DEA: 021J4604 EFIS: 0220000081
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-34.5/38.8,88.0/92.0
Work Description: HMA OVERLAY, REPLACE AC SURFACING, SHOULDER BACKING & TRAFFIC STRIPE.
Location Description: SISKIYOU COUNTY NEAR HAPPY CAMP FROM 0.1 MILE EAST OF OAK FLAT CREEK BRIDGE TO 0.1 MILE EAST OF BENJAMIN CREEK ROAD AND FROM 0.3 MILE WEST OF BEAVER CREEK BRIDGE TO 1.0 MILE WEST OF LUMGREY CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2021-06-21-18
TL Number from the TL Form: 853076
Sample Submitted By Organization: CT D02 - North Region Materials Lab
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Reclaimed Asphalt Pavement
Sample Taken Date: 06/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/21/2021
The quantity of what the sample constitutes: PSE 2 bags at 410 Tons
A brief description of the sample: 3/8 Inch RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: D78848
Structure unique identifier:
Structure name: Not Applicable
The fabricator/manufacturer/facility name: Tullis Inc - Northstate Asphalt - Redding, CA