Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993623 DEA: 022J3704 EFIS: 0221000071
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-299-50.5/56.5,93.5/99.3
Work Description: ASPHALT RUBBER BINDER SEAL COAT, COLD PLANE AC PAVEMENT AND HMA.
Location Description: SHASTA COUNTY NEAR MONTGOMERY CREEK FROM 0.2 MILE WEST OF OAK POINT DRIVE TO OLD BERTAGNA PLACE AND FROM 0.1 MILE EAST OF SIERRA CENTER DRIVE TO LASSEN COUNTY LINE
Contractor Name: AMERICAN PAVEMENT SYSTEMS, INC.
Contractor Address: 1012 11th St., Modesto, CA 95354
Resident Engineer: Mike Zdenek Structure Rep.: Unknown
DIME Sample ID: 2022-07-22-62
TL Number from the TL Form: 866058
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 Rubber Binder
Sample Taken Date: 07/22/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2022
The quantity of what the sample constitutes: 1 can of Asphalt Rubber Binder
A brief description of the sample: for chip seal acceptance
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina and American Pavement Systems
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
