Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 44444 DEA: ASCP EFIS: ASCP
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Asphalt Supplier Certification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-06-28-35
TL Number from the TL Form:
Sample Submitted By Organization: San Joaquin Refinery - Bakersfield
Sample Organization Contact: (661) 327-8248
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 06/28/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/28/2021
The quantity of what the sample constitutes: 1 of 2 cans
A brief description of the sample: PG70-10 Asphalt Binder
From where was the sample collected: Manufacturer
Laboratory sample identification: 7010210628
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery, Bakersfield, CA
Performance Grade: PG 70-10
Modified: No
Lot number: 7010210628
Sublot number:
Tank number: 9001
Time of sample: 8:15 am
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
