Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993493 DEA: 100Q1224 EFIS: 1014000168
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-28.2/R37.3
Work Description: WIDEN CONCRETE PAVEMENT LANES AND BRIDGES.
Location Description: MERCED COUNTY IN AND NEAR LIVINGSTON FROM 0.8 MILE SOUTH OF HAMMATT AVENUE OVERCROSSING TO STANISLAUS COUNTY LINE
Contractor Name: SECURITY PAVING COMPANY, INC. - Bassel Jamaleddine
Contractor Address: 3075 Townsgate Rd. Suite 200, Westlake Village CA 91361
Resident Engineer: Tofael Anwar Structure Rep.: Karen Sampson
DIME Sample ID: 2023-04-05-60
TL Number from the TL Form: 033817
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 04/05/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/18/2023
The quantity of what the sample constitutes: 1 of 2 cans
A brief description of the sample: 2 Cans of Asphalt Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichart hot plant
Performance Grade: PG 64-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Teichert - Santa Fe Winton
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
