Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 44444 DEA: ASCP EFIS: ASCP
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Asphalt Supplier Certification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-07-01-7
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: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 07/01/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/14/2023
The quantity of what the sample constitutes: 1 of 1
A brief description of the sample: Tank 1
From where was the sample collected: Manufacturer
Laboratory sample identification: PG58227123T1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cchowchilla, CA
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number: 1
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Albina Asphalt - Chowchilla CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2023-07-01-7-1
Test Method: AASHTO T315-22: Standard Method of Test for Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) (Dynamic Shear)
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard, Room 225,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (916) 227-7302
Data has not been verified.
