Sample Record

Owner Lab

  • CT D03 - Field Laboratory

DIME Sample ID 2021-04-01-27

Project Information

Project IdentifiersProject ID: 212914
DEA: 031E0604
EFIS: 0312000068
DIST-CO-RTE-PM03-YUB-70-15.5/16.5
Award Date07/31/2019
Closeout DateNot set
Work DescriptionSIMMERLY SLOUGH BRIDGE REPLACEMENT BR 16-0019 WITH BR 16-0055.
Location DescriptionNEAR MARYSVILLE, FROM 0.1 MILE NORTH OF BINNEY JUNCTION UNDERPASS TO 0.3 MILE NORTH OF LAURELLEN ROAD, AT SIMMERLY SLOUGH BRIDGE BR 16-0019.
QA Service Level1 (Verified on 08/22/2019)

Sample Information

Sample Taken Date04/01/2021 Sample Unique Key27
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 testing04/01/2021
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 byTeichert Personnel (SAMPLER) Last name of sampler or witnessed by Brad McKeehan (WITNESS)
Title of samplerUnknown Telephone number of samplerUnknown
Laboratory sample identificationJMF21-020A Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert-Hallwood Drum Plant Transportation Laboratory (TL) NumberC706328
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure nameNot Applicable

Material Information

Material TypeAsphalt Binder Performance GradePG 64-16
ModifiedNo Lot number
Sublot number Tank number
Time of sample HMA SupplierTeichert - Hallwood Drum Plant
Asphalt Binder SupplierPacific Northwest Oil - Stockton CA MultigradeNo
Multigrade TypeNot set JMF Verification ID JMF3513-2021-49

Submitted Tests

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