Sample Record

Owner Lab

  • CT HQ - Sacramento Hot Mix Asphalt Laboratory

DIME Sample ID 2021-01-25-10

Project Information

Project IdentifiersProject ID: 66667
DEA: JMFPP
EFIS: 0019000043
DIST-CO-RTE-PM59---
Award DateNot set
Closeout DateNot set
Work DescriptionSpecial project for submitting Sample information for JMF Prequalification Program.
Location DescriptionNot set
QA Service LevelNOT VERIFIED

Sample Information

Sample Taken Date01/25/2021 Sample Unique Key10
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 testing01/26/2020
Sample typeVerification A brief description of the samplePG 64-16
The quantity of what the sample constitutes2 cans From where was the sample collectedSupplier
First name of sampler or witnessed byIgnocencio Last name of sampler or witnessed byHerrera
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameValero Oil 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 64-16
Modified Lot number
Sublot number Tank number
Time of sample HMA SupplierNot set
Certified Asphalt SupplierNot set MultigradeNot set
Multigrade TypeNot set Asphalt Binder Mix NumberNot set

JMF Information

Verification IDJMF3513-2021-9 Date Created01/26/2021
JMF Submittal IDJMF3511-208-2021-11 JMF StatusSubmittal Authorized For Use
Producer Mix ID411101510-LB Authorized Date02/11/2021

Submitted Tests

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

File NameExtensionDate UploadedActions
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Test File Attachments