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: 2021-08-16-56
TL Number from the TL Form: c779892
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Modifier
Sample Taken Date: 08/16/2021
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: Extender oil
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KRC Orland
