Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215721 DEA: 010K5704 EFIS: 0120000118
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-40.5/45.7
Work Description: COLD PLANE AC PAVEMENT, PLACE RHMA-G AND TRAFFIC STRIPING.
Location Description: HUMBOLDT COUNTY NEAR DINSMORE FROM VAN DUZEN RIVER BRIDGE TO TRINITY COUNTY LINE
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: P. O. BOX 1006, EUREKA, CA 95502-1006
Resident Engineer: Joaquin Rodriguez Structure Rep.: Unknown
DIME Sample ID: 2022-05-23-22
TL Number from the TL Form: 706375
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: 05/23/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/25/2022
The quantity of what the sample constitutes: 1of1
A brief description of the sample: psue
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Mercer Fraser
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
