Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215414 DEA: 101J2104 EFIS: 1018000144
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-99-9.4/15.0
Work Description: PLACE RHMA, COLD PLANE ASPHALT CONCRETE, TRAFFIC STRIPING.
Location Description: SAN JOAQUIN COUNTY IN AND NEAR STOCKTON FROM 0.2 MILE NORTH OF LATHROP ROAD OVERCROSSING TO 0.3 MILE NORTH OF ARCH ROAD UNDERCROSSING
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 265 VAL DERVIN PARKWAY, STOCKTON, CA 95201
Resident Engineer: Chris Hanson Structure Rep.: Unknown
DIME Sample ID: 2021-09-13-42
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 09/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/07/2021
The quantity of what the sample constitutes: NO TEST
A brief description of the sample: PG 64-16
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Materials Vernalis
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
