Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993301 DEA: 060U2804 EFIS: 0615000293
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-245-1.4,4.2
Work Description: PRECAST PRESTRESSED CONCRETE BOX GIRDER AND SLAB, BRIDGE REMOVAL.
Location Description: TULARE COUNTY NEAR WOODLAKE AT YOKOHL CREEK BRIDGE AND AT KAWEAH RIVER BRIDGE
Contractor Name: MCM Construction
Contractor Address: PO Box 620, North Highlands, Ca 95660
Resident Engineer: Mike Garrett Structure Rep.: Benajamin Holton
DIME Sample ID: 2023-03-25-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 341-4165
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 03/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/25/2023
The quantity of what the sample constitutes: 278 Tons
A brief description of the sample: 3/4" HMA-A PG 70-10
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Porterville Rock and Recycle
Performance Grade: PG 70-10
Modified: No
Lot number: 1
Sublot number: 4
Tank number: 9001
Time of sample: 9:17
HMA Supplier: Porterville Asphalt & Rock
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number: 21902303219001
