Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215615 DEA: 101L2304 EFIS: 1020000163
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-4-5.4/13.4
Work Description: COLD PLANE ASPHALT CONCRETE PAVEMENT AND RESURFACE WITH HMA AND RHMA.
Location Description: SAN JOAQUIN COUNTY NEAR STOCKTON FROM 1 MILE EAST OF MIDDLE RIVER BRIDGE TO 0.1 MILE WEST OF JOHN TURK ROAD
Contractor Name: GEORGE REED , INC.
Contractor Address: P.O. BOX 4760, MODESTO, CA 95352
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2021-09-15-44
TL Number from the TL Form: c21MC0017
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 09/15/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2021
The quantity of what the sample constitutes: 1 can
A brief description of the sample: 64-28M
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Clements Plant
Performance Grade: PG 64-28 M
Modified: Yes
Lot number: 1
Sublot number: 5
Tank number:
Time of sample:
HMA Supplier: George Reed
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number: