Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215777 DEA: 032H6304 EFIS: 0317000166
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-162-18.4/19.9
Work Description: PLACE RUBBERIZED HMA AND ROADWAY EXCAVATION.
Location Description: BUTTE COUNTY IN AND NEAR OROVILLE FROM FOOTHILL BOULEVARD TO GOLD COUNTRY CASINO ENTRANCE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Dwayne Grandy Structure Rep.: Unknown
DIME Sample ID: 2022-10-01-7
TL Number from the TL Form: 779502
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/01/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2022
The quantity of what the sample constitutes: 1 QT JUG
A brief description of the sample: SS-1H 80/20
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Desilva Gates
