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: 2021-09-09-35
TL Number from the TL Form: 21MC0001
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 Rubber Binder
Sample Taken Date: 09/09/2021
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: Asphalt Rubber Binder
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Clements Plant
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 1
Sublot number: 16
Asphalt Rubber Binder Mix Number: