Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214336 DEA: 07302404 EFIS: 0713000488
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-101-37/40
Work Description: PADRE JUAN REHAB
Location Description: VEN 101
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4820 McGrath Street, Suite 101, Ventura, CA 93003
Resident Engineer: Alfred Ira Structure Rep.: Unknown
DIME Sample ID: 2021-07-23-6
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 07/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/23/2021
The quantity of what the sample constitutes: 1 Quart
A brief description of the sample: Asphalt Binder
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Santa Paula
Performance Grade: PG 64-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2021-07-23-6-2
Test Method: AASHTO T240-17: Standard Method of Test for Effect of Heat and Air on a Moving Film of Asphalt Binder (Rolling Thin-Film Oven Test)
Verified Date: 08/15/2021
Date Tested: 07/26/2021
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
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Is mass change based on one or two containers?
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Two
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Average mass change
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0.075 percent
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