Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994696 DEA: 100Y7704 EFIS: 1015000008
QA Service Level: 1
DIST-CO-RTE-PM: 10-MPA-140-12.0/22.1
Work Description: REPLACE AC SURFACING, PLACE HMA AND RHMA, AND BRIDGE REPAIR.
Location Description: MARIPOSA COUNTY NEAR MARIPOSA FROM 1.3 MILES EAST OF CATHEYS VALLEY PARK TO 0.1 MILE NORTH OF ROUTE 49
Contractor Name: GEORGE REED, INC.
Contractor Address: 140 EMPIRE AVE, MODESTO CA 95354
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2024-08-27-57
TL Number from the TL Form: C023434
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/27/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2024
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: TACK OIL 3/4 HMA PG 64-28 M
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: PACIFIC NORTH WEST OIL
