Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215680 DEA: 010K4804 EFIS: 0120000102
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-20-0.7/5.2,5.9/8.2
Work Description: RHMA OVERLAY, COLD PLANE AC PAVEMENT AND PRECOATED AGGREGATE.
Location Description: LAKE COUNTY NEAR UPPER LAKE FROM 0.1 MILE WEST OF BLUE LAKES ROAD TO 0.4 MILE WEST OF WITTER SPRINGS ROAD AND FROM 0.1 MILE EAST OF BACHELOR CREEK BRIDGE TO 0. 1 MILE WEST OF ROUTE 29
Contractor Name: Ghilloti Construction Co.
Contractor Address: 246 Ghilloti Ave, Santa Rosa CA 95407
Resident Engineer: Dan Kraft Structure Rep.: Unknown
DIME Sample ID: 2021-09-28-45
TL Number from the TL Form: 930509
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: 09/28/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2021
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: Western Emulsions - White City OR
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
