Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215572 DEA: 032G1104 EFIS: 0320000230
QA Service Level: 1
DIST-CO-RTE-PM: 03-GLE-162-66.6/76.3
Work Description: PLACE RHMA AND COLD IN-PLACE RECYCLE.
Location Description: GLENN COUNTY IN AND NEAR WILLOWS FROM 0.2 MILE EAST OF N SHASTA STREET TO 1.0 MILE EAST OF ROAD X
Contractor Name: BALDWIN CONTRACTING CO., INC. DBA KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 Skyway, CHICO, CA 95928
Resident Engineer: Dan Reechs Structure Rep.: Unknown
DIME Sample ID: 2021-06-30-37
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 06/30/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/26/2021
The quantity of what the sample constitutes: 2 cans
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Knife River Construction - Orland Drum Plant
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
