Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215558 DEA: 101J1304 EFIS: 1018000136
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL,ALP-4,207-R58.0/R65.9,0.0/1.4
Work Description: COLD PLANE EXISTING PAVEMENT AND RESURFACE WITH HMA.
Location Description: CALAVERAS AND ALPINE COUNTIES NEAR TAMARACK ON ROUTE 4 FROM 1.8 MILES WEST OF CABBAGE PATCH LOG ROAD TO ALPINE COUNTY LINE AND NEAR LAKE ALPINE ON ROUTE 207 FROM JUNCTION 4/207 TO END OF ROUTE (MT REBA RESORT)
Contractor Name: GEORGE REED , INC.
Contractor Address: 140 EMPIRE AVE, MODESTO CA 95354
Resident Engineer: Pawan Garg Structure Rep.: Unknown
DIME Sample ID: 2021-07-13-27
TL Number from the TL Form: 034888
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: 07/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/26/2021
The quantity of what the sample constitutes: 1 can
A brief description of the sample: NO TEST PG64-28M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Marathon
Performance Grade: PG 64-28 M
Modified:
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:
