Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-03-12-20

Project Information

Project IdentifiersProject ID: 215307
DEA: 033F5004
EFIS: 0313000019
DIST-CO-RTE-PM03-GLE-5-R7.4/R17.0
Award Date01/04/2021
Closeout Date11/30/2021
Work DescriptionPLACE HMA (TYPE A) AND MODIFY INTERCONNECTION CONDUIT AND CABLE.
Location DescriptionGLENN COUNTY IN AND NEAR WILLOWS AT VARIOUS LOCATIONS FROM COUNTY ROAD 57 OVERCROSSING TO COUNTY ROAD 33 OVERCROSSING
QA Service Level1 (Verified on 12/02/2020)

Sample Information

Sample Taken Date03/12/2021 Sample Unique Key20
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 testing03/12/2021
Sample typeVerification A brief description of the samplePG 64-16
The quantity of what the sample constitutesJMF Verification From where was the sample collectedManufacturer
First name of sampler or witnessed byBrad McKeehan (WITNESS) Last name of sampler or witnessed byKRC Personnel (SAMPLER)
Title of sampler Telephone number of sampler
Laboratory sample identificationJMF21-003 Linked DIME Sample ID
The fabricator/manufacturer/facility nameKnife River Construction - Orland Drum Plant Transportation Laboratory (TL) NumberC778174
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 64-16
ModifiedNo Lot number
Sublot number Tank number
Time of sample HMA Supplier
Asphalt Binder SupplierValero Marketing & Supply - Benicia CA MultigradeNot set
Multigrade TypeNot set JMF Verification ID JMF3513-2021-39

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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