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: TULLIS, INC.
Contractor Address: 16951 CLEAR CREEK ROAD, REDDING CA 96001
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2021-06-29-30
TL Number from the TL Form:
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: 06/29/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/06/2021
The quantity of what the sample constitutes: 1 of 1 can
A brief description of the sample: PG58-34M
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 58-34 M
Modified: Yes
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:
