Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215296 DEA: 031F1504 EFIS: 0300001101
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50-R7.7/R9.5
Work Description: PLACE HMA, RHMA, AGGREGATE BASE AND FIBER OPTIC SYSTEM.
Location Description: SACRAMENTO COUNTY IN AND NEAR RANCHO CORDOVA FROM BRADSHAW ROAD OVERCROSSING TO MATHER FIELD OVERCROSSING
Contractor Name: DeSILVA GATES CONSTRUCTION
Contractor Address: 3855 N Freeway, Ste. 100, Sacramento, CA 95834
Resident Engineer: Ephrem Teweldeburhan Structure Rep.: Unknown
DIME Sample ID: 2021-07-14-1
TL Number from the TL Form: 850189
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: 07/14/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/14/2021
The quantity of what the sample constitutes: 1 CAN
A brief description of the sample: PG 64-16 Asphalt Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins Batch Plant
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Marathon Petroleum Co. LP - Elk Grove CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
