Sample Record
Owner Lab
- CT D02 - North Region Materials Lab
DIME Sample ID 2020-10-20-7
Sample is locked from editing. info
Project Information
| Project Identifiers | Project ID: 213469 DEA: 024C40V4 EFIS: 0218000125 |
|---|---|
| DIST-CO-RTE-PM | 02-SHA-5-R3.8/R11.7 |
| Award Date | 11/06/2018 |
| Closeout Date | Not set |
| Work Description | WIDEN TO 6 LANES, BRIDGE REPLACEMENT AND WIDENING AND ROADWAY REHAB |
| Location Description | SHASTA COUNTY IN AND NEAR ANDERSON FROM ROUTE 5/273 SEPARATION TO 0.4 MILE SOUTH OF CHURN CREEK ROAD OVERCROSSING |
| QA Service Level | 1 (Verified on 12/31/2018) |
Sample Information
| Sample Taken Date | 10/20/2020 | Sample Unique Key | 7 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | Yes | Date that the sample was received by the laboratory/organization performing the testing | 10/23/2020 |
| Sample type | Verification | A brief description of the sample | Asphalt Rubber Binder |
| The quantity of what the sample constitutes | ARB Rcvd 2 cans #21 Test | From where was the sample collected | Source |
| First name of sampler or witnessed by | C | Last name of sampler or witnessed by | Bryant |
| Title of sampler | TET | Telephone number of sampler | |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Valero | Transportation Laboratory (TL) Number | 853473 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Asphalt Rubber Binder | Asphalt modifier supplier | |
|---|---|---|---|
| Performance Grade | PG 64-16 | Lot number | |
| Sublot number | JMF Verification ID | JMF3513-2021-83 |