Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215183 DEA: 101C1704 EFIS: 1014000144
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-R12.7/17.8
Work Description: RECONSTRUCT ROADWAY WITH ROADWAY EXCAVATION, PLACE HMA AND CRCP.
Location Description: MERCED COUNTY IN MERCED FROM 0.2 MILE SOUTH OF CHILDS AVENUE OVERCROSSING TO 0.2 MILE SOUTH OF FRANKLIN ROAD OVERCROSSING.
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 4533 E. Citron Ave, Fresno, CA 93725
Resident Engineer: Wali Waziri Structure Rep.: George Samuel
DIME Sample ID: 2023-01-31-42
TL Number from the TL Form:
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: 01/31/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/29/2023
The quantity of what the sample constitutes: 2 cans of binder
A brief description of the sample: Asphalt binder
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert - Santa Fe Winton
Performance Grade: PG 64-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
