Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995087 DEA: 051P5904 EFIS: 0522000086
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-0.0/5.0
Work Description: Cold plane, RHMA-G
Location Description: Watsonville area, County line to Scenic pullout
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 3500 American River Dr, Sacramento CA 95864
Resident Engineer: Tyler Lavering Structure Rep.: Unknown
DIME Sample ID: 2023-09-25-34
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 09/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/25/2023
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: PG64-10 SJR
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granit Salinas Batch Plant
Performance Grade: PG 64-10
Modified: No
Lot number: 1
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier: Granite Salinas Batch Plant
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number: 20_1580
