Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-03-15-18

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 Date07/28/2022
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 Date03/15/2021 Sample Unique Key18
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 testing03/15/2021
Sample typeVerification A brief description of the samplePG 64-16 Asphalt Binder
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 sampler Telephone number of sampler
Laboratory sample identificationJMF21-012 Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert Perkins Batch Plant Transportation Laboratory (TL) NumberC849136
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 MultigradeNo
Multigrade TypeNot set JMF Verification ID JMF3513-2021-47

Submitted Tests

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