Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-03-02-33

Project Information

Project IdentifiersProject ID: 215073
DEA: 034H5604
EFIS: 0318000332
DIST-CO-RTE-PM03-PLA-65-R12.9/R13.1
Award Date09/02/2020
Closeout Date09/23/2021
Work DescriptionCONSTRUCT SLOPE PAVING AND PLACE EROSION CONTROL.
Location DescriptionPLACER COUNTY IN LINCOLN AT THE SOUTH INGRAM SLOUGH BRIDGE
QA Service Level1 (Verified on 09/10/2020)

Sample Information

Sample Taken Date03/02/2021 Sample Unique Key33
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 testing03/02/2021
Sample typeVerification A brief description of the samplePG 64-16 (mix 3/4" HMA - A w/12% RAP)
The quantity of what the sample constitutesJMF Verification From where was the sample collectedManufacturer
First name of sampler or witnessed byVulcan Personnel (SAMPLER) Last name of sampler or witnessed byDavid Drane (WITNESS)
Title of sampler Telephone number of sampler
Laboratory sample identificationJMF21-008 Linked DIME Sample ID
The fabricator/manufacturer/facility nameVulcan Materials Company - Roseville Transportation Laboratory (TL) Numberc764977
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 SupplierMarathon Petroleum Co. LP - Elk Grove CA MultigradeNot set
Multigrade TypeNot set JMF Verification ID JMF3513-2021-43

Submitted Tests

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