Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214518 DEA: 034F3704 EFIS: 0314000152
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-174-2.7/4.6
Work Description: REALIGN ROADWAY CURVES.
Location Description: NEVADA COUNTY NEAR PEARDALE FROM MAPLE WAY TO YOU BET ROAD
Contractor Name: DE SILVA GATES CONSTRUCTION
Contractor Address: 11555 DUBLIN BLVD, DUBLIN, CA 94568
Resident Engineer: Jeff Johnson Structure Rep.: Unknown
DIME Sample ID: 2021-10-16-8
TL Number from the TL Form: 707320
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 10/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/29/2021
The quantity of what the sample constitutes: PG64-16
A brief description of the sample: 1 OF 1 NO TEST 10-16
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
