Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213411 DEA: 030H10U4 EFIS: 0317000246
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-5-9.7/24.9
Work Description:
Location Description: Construction on state highway in Sacramento County in and near Sacramento from 1.1 miles south of Elk Grove Boulevard to American River Viaduct
Contractor Name: NOR CAL PAVING TEICHERT/GRANITE
Contractor Address: 400 Sunrise Ave. Ste. #300, Roseville, CA 95661
Resident Engineer: Daniel Tecle Structure Rep.: Pha Tran
DIME Sample ID: 2021-09-13-34
TL Number from the TL Form: c060167
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: 09/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2021
The quantity of what the sample constitutes: 2 Cans
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: Teichert Perkins
Performance Grade: PG 64-28 M
Modified: Yes
Lot number: 7
Sublot number: 8
Tank number:
Time of sample:
HMA Supplier: Teichert Perkins
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number: