Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215500 DEA: 101J1904 EFIS: 1018000132
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-140-37.4/44.8
Work Description: COLD IN-PLACE RECYCLING AND RESURFACE PAVEMENT WITH HMA.
Location Description: MERCED COUNTY IN AND NEAR MERCED FROM SANTA FE AVENUE TO HAYDEN ROAD
Contractor Name: GEORGE REED , INC.
Contractor Address: 140 EMPIRE AVE, MODESTO CA 95354
Resident Engineer: Muhammad M. Rahman Structure Rep.: Unknown
DIME Sample ID: 2021-08-25-43
TL Number from the TL Form: 035004
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: 08/25/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/10/2021
The quantity of what the sample constitutes: 1 of 2 cans
A brief description of the sample: PG 64-28 PM
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: 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:
