Sample Record

Owner Lab

  • CT D05 - San Luis Obispo District Laboratory

DIME Sample ID 2020-09-17-22

Project Information

Project IdentifiersProject ID: 214629
DEA: 051H9304
EFIS: 0517000017
DIST-CO-RTE-PM05-SLO-46-R17.2/R17.6
Award Date04/07/2020
Closeout Date10/20/2022
Work DescriptionCONSTRUCT ROUNDABOUT.
Location DescriptionSAN LUIS OBISPO COUNTY NEAR TEMPLETON FROM 0.2 MILE WEST TO 0.2 MILE EAST OF VINEYARD DRIVE
QA Service Level1 (Verified on 02/20/2020)

Sample Information

Sample Taken Date09/17/2020 Sample Unique Key22
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing09/25/2020
Sample typeVerification A brief description of the sampleQuart Can Binder
The quantity of what the sample constitutesOne JMF Verification From where was the sample collectedJob Site
First name of sampler or witnessed byLarry Last name of sampler or witnessed byScott
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameValero Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 64-10
Modified Lot number
Sublot number Tank numberNot set
Time of sampleNot set HMA SupplierNot set
Certified Asphalt SupplierNot set MultigradeNot set
Multigrade TypeNot set Asphalt Binder Mix NumberNot set

JMF Information

Verification IDJMF3513-2020-206 Date Created10/01/2020
JMF Submittal IDJMF3511-173-2020-292 JMF StatusSubmittal Authorized For Use
Producer Mix IDA1381F015 Authorized Date10/01/2020

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments