Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993474 DEA: 101N3204 EFIS: 1021000167
QA Service Level: 1
DIST-CO-RTE-PM: 10-TUO-132-R4.7/6.0
Work Description: COLD PLANE EXISTING PAVEMENT AND RESURFACE WITH RHMA.
Location Description: TUOLUMNE COUNTY NEAR HAYWARD FROM 0.7 MILE EAST OF BONDS FLAT ROAD TO LAS PALMAS WAY
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 2716 Granite Court, Fresno, CA 93706
Resident Engineer: Wali Waziri Structure Rep.: Unknown
DIME Sample ID: 2022-05-25-84
TL Number from the TL Form: 976940
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: 05/25/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2022
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: Rubber Binder
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernalis
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 1
Sublot number: 1
Asphalt Rubber Binder Mix Number:
