Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993279 DEA: 010E0904 EFIS: 0113000123
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20-33.3/34.4
Work Description: CONSTRUCT NEW BRIDGE, REMOVE TWO BRIDGES, EARTHWORK AND PAVING. (Bridge No. 10-0310)
Location Description: MENDOCINO COUNTY NEAR UKIAH FROM 0.3 MILE WEST OF RUSSIAN RIVER BRIDGE AND OVERHEAD TO 0.3 MILE EAST OF COUNTY ROAD 144
Contractor Name: Myers & Sons Construction LLC
Contractor Address: 4600 Northgate Blvd, Suite 100, Sacramento, CA 95838
Resident Engineer: Geoffrey Wright Structure Rep.: Kari Forbes
DIME Sample ID: 2024-08-16-56
TL Number from the TL Form: 778436
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 08/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/28/2024
The quantity of what the sample constitutes: 1 can binder
A brief description of the sample: 1 can
From where was the sample collected: Source
Laboratory sample identification: 24-167
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite HWY 175
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
