Sample Record

Owner Lab

  • CT D03 - Olivehurst Northern Regional Laboratory

DIME Sample ID 2020-10-25-10

Project Information

Project IdentifiersProject ID: 213411
DEA: 030H10U4
EFIS: 0317000246
DIST-CO-RTE-PM03-SAC-5-9.7/24.9
Award Date05/01/2019
Closeout Date02/22/2024
Work DescriptionNot set
Location DescriptionConstruction on state highway in Sacramento County in and near Sacramento from 1.1 miles south of Elk Grove Boulevard to American River Viaduct
QA Service Level1 (Verified on 07/19/2019)

Sample Information

Sample Taken Date10/25/2020 Sample Unique Key10
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 testing01/07/2021
Sample typeVerification A brief description of the samplePG 64-28m Valero
The quantity of what the sample constitutesJMF Verification From where was the sample collectedManufacturer
First name of sampler or witnessed byJ. Buscheck (WITNESS) Last name of sampler or witnessed byTeichert Personnel (SAMPLER)
Title of sampler Telephone number of sampler
Laboratory sample identificationJMF21-002 Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert Perkins Batch Plant 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 64-28 M
ModifiedYes Lot number
Sublot number Tank number
Time of sample HMA Supplier
Certified Asphalt SupplierValero Marketing & Supply - Benicia CA MultigradeNot set
Multigrade TypeNot set Asphalt Binder Mix NumberNot set

JMF Information

Verification IDJMF3513-2021-34 Date Created03/19/2021
JMF Submittal IDJMF3511-23-2021-46 JMF StatusSubmittal Authorized For Use
Producer Mix IDPN202002-SRF Authorized Date09/10/2021

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