Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993576 DEA: 09389604 EFIS: 0921000043
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO,INY-6,168-0.8/4.9,30.0/33.5
Work Description: COLD PLANE AC PAVEMENT AND PLACE HMA (TYPE A).
Location Description: MONO AND INYO COUNTIES ON ROUTE 6 NEAR CHALFANT FROM 2.5 MILES WEST OF CHALFANT LOOP ROAD TO 0.2 MILE EAST OF BROWN SUBDIVISION ROAD AND ON ROUTE 168 ABOUT 12 MILES EAST OF BIG PINE FROM 1.3 MILES WEST TO 1.7 MILES EAST OF WHITE MOUNTAIN ROAD
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-08-16-52
TL Number from the TL Form: 999904
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: 08/16/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/29/2022
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: PG 64-28M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bishop
Performance Grade: PG 64-28 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample: AM
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
