Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-03-05-25

Project Information

Project IdentifiersProject ID: 214492
DEA: 033F5404
EFIS: 0313000136
DIST-CO-RTE-PM03-SAC-99,160-4.5/5.7,R44.5
Award Date01/24/2020
Closeout DateNot set
Work DescriptionFURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE.
Location DescriptionSACRAMENTO COUNTY NEAR GALT ON ROUTE 99 FROM NORTH OF MINGO ROAD TO SOUTH OF ARNO ROAD OVERCROSSING AND IN SACRAMENTO ON ROUTE 160 AT AMERICAN RIVER BRIDGE
QA Service Level1 (Verified on 10/23/2019)

Sample Information

Sample Taken Date03/05/2021 Sample Unique Key25
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 testing03/08/2021
Sample typeVerification A brief description of the sampleAsphalt Modifier (PG-64-16)
The quantity of what the sample constitutesJMF Verification From where was the sample collectedManufacturer
First name of sampler or witnessed bySam Mossallem (Witness) Last name of sampler or witnessed byTeichert Personnel (SAMPLER)
Title of samplerTeichert Personnel Telephone number of samplerUnknown
Laboratory sample identificationJMF21-009 Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert Perkins - Continuous Plant Dreyer Drum Transportation Laboratory (TL) NumberC 849135
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Modifier Asphalt Modifier TypeTricor Refining
JMF Verification ID JMF3513-2021-45

Submitted Tests

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