Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993523 DEA: 051N6604 EFIS: 0521000075
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-35-3.5/7.7
Work Description: COLD PLANE EXISTING ROADWAY AND PLACE RHMA-G OVERLAY.
Location Description: SANTA CRUZ COUNTY NEAR LEXINGTON HILLS FROM BEAR CREEK ROAD TO SANTA CLARA COUNTY LINE
Contractor Name: Granite Rock Company
Contractor Address: 411 Walker Street, Watsonville, CA 95076
Resident Engineer: Pat Dussell Structure Rep.: Unknown
DIME Sample ID: 2022-05-17-48
TL Number from the TL Form: C748989
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 05/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2022
The quantity of what the sample constitutes: 1 CAN
A brief description of the sample: BINDER
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: A.R. WILSON QUARRY
Performance Grade: PG 64-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
