Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214700 DEA: 030F2804 EFIS: 0312000069
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-7.1/9.4
Work Description: Dillard Overcrossing and McConnel Overhead
Location Description: Hwy 99, Elk Grove, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: Saed Masoud Structure Rep.: Chau Ha
DIME Sample ID: 2021-09-20-66
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 09/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2021
The quantity of what the sample constitutes: Cans of Mix
A brief description of the sample: Asphalt Binder PG58-22(Valero)
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero-Benicia Asphalt Plant
Performance Grade: PG 58-22
Modified:
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:
