Sample Record
Owner Lab
- CT D03 - Olivehurst Northern Regional Laboratory
DIME Sample ID 2021-03-15-18
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 214492 DEA: 033F5404 EFIS: 0313000136 |
|---|---|
| DIST-CO-RTE-PM | 03-SAC-99,160-4.5/5.7,R44.5 |
| Award Date | 01/24/2020 |
| Closeout Date | 07/28/2022 |
| Work Description | FURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE. |
| Location Description | SACRAMENTO 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 Level | 1 (Verified on 10/23/2019) |
Sample Information
| Sample Taken Date | 03/15/2021 | Sample Unique Key | 18 |
|---|---|---|---|
| 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 testing | 03/15/2021 |
| Sample type | Verification | A brief description of the sample | PG 64-16 Asphalt Binder |
| The quantity of what the sample constitutes | JMF Verification | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Sam Mossallem (WITNESS) | Last name of sampler or witnessed by | Teichert Personnel (SAMPLER) |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | JMF21-012 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Teichert Perkins Batch Plant | Transportation Laboratory (TL) Number | C849136 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Asphalt Binder | Performance Grade | PG 64-16 |
|---|---|---|---|
| Modified | No | Lot number | |
| Sublot number | Tank number | ||
| Time of sample | HMA Supplier | ||
| Certified Asphalt Supplier | Valero Marketing & Supply - Benicia CA | Multigrade | No |
| Multigrade Type | Not set | Asphalt Binder Mix Number | Not set |
JMF Information
| Verification ID | JMF3513-2021-47 | Date Created | 04/26/2021 |
|---|---|---|---|
| JMF Submittal ID | JMF3511-23-2021-59 | JMF Status | Submittal Authorized For Use |
| Producer Mix ID | PN202102-SP | Authorized Date | 09/10/2021 |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||