Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215126 DEA: 010G33U4 EFIS: 0120000002
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-20-5.1/6.3
Work Description: Widen shoulders and replace bridge with box culvert.
Location Description: LAKE COUNTY NEAR UPPER LAKE FROM 0.4 MILE WEST OF WITTER SPRINGS ROAD TO 0.4 MILE EAST OF BACHELOR CREEK BRIDGE
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 Fourth St., Berkeley, CA 94710
Resident Engineer: Katharine Perrin Structure Rep.: Unknown
DIME Sample ID: 2021-09-13-57
TL Number from the TL Form: 636952
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: 10/21/2021
The quantity of what the sample constitutes: 1 CAN
A brief description of the sample: NO TEST,
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
