Sample Record
Owner Lab
- CT D03 - Olivehurst Northern Regional Laboratory
DIME Sample ID 2021-04-01-27
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 212914 DEA: 031E0604 EFIS: 0312000068 |
|---|---|
| DIST-CO-RTE-PM | 03-YUB-70-15.5/16.5 |
| Award Date | 07/31/2019 |
| Closeout Date | 08/30/2023 |
| Work Description | SIMMERLY SLOUGH BRIDGE REPLACEMENT BR 16-0019 WITH BR 16-0055. |
| Location Description | NEAR 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 Level | 1 (Verified on 08/22/2019) |
Sample Information
| Sample Taken Date | 04/01/2021 | Sample Unique Key | 27 |
|---|---|---|---|
| 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 | 04/01/2021 |
| 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 | Teichert Personnel (SAMPLER) | Last name of sampler or witnessed by | Brad McKeehan (WITNESS) |
| Title of sampler | Unknown | Telephone number of sampler | Unknown |
| Laboratory sample identification | JMF21-020A | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Teichert-Hallwood Drum Plant | Transportation Laboratory (TL) Number | C706328 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Not Applicable |
Material Information
| Material Type | Asphalt Binder | Performance Grade | PG 64-16 |
|---|---|---|---|
| Modified | No | Lot number | |
| Sublot number | Tank number | ||
| Time of sample | HMA Supplier | Teichert - Hallwood Drum Plant | |
| Certified Asphalt Supplier | Pacific Northwest Oil - Stockton CA | Multigrade | No |
| Multigrade Type | Not set | Asphalt Binder Mix Number | Not set |
JMF Information
| Verification ID | JMF3513-2021-49 | Date Created | 05/01/2021 |
|---|---|---|---|
| JMF Submittal ID | JMF3511-23-2021-61 | JMF Status | Submittal Authorized For Use |
| Producer Mix ID | 309-40432407-P | 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. | |||