Sample Record

Owner Lab

  • CT D03 - Olivehurst Northern Regional Laboratory

DIME Sample ID 2021-04-05-32

Project Information

Project IdentifiersProject ID: 214764
DEA: 032H6404
EFIS: 0317000167
DIST-CO-RTE-PM03-SAC-12,160-0.4/0.9,L10.5/R0.2
Award Date05/20/2020
Closeout Date05/11/2022
Work DescriptionMODIFY SIGNAL AND LIGHTING SYSTEM, PLACE RHMA AND ROADWAY EXCAVATION.
Location DescriptionSACRAMENTO COUNTY NEAR RIO VISTA ON ROUTE 12 FROM 0.6 MILE EAST OF SACRAMENTO RIVER BRIDGE TO 5.2 MILES WEST OF MOKELUMNE RIVER BRIDGE AND ON ROUTE 160 FROM 3.6 MILES NORTH OF THREE MILE SLOUGH BRIDGE TO 2.7 MILES SOUTH OF CIRCLE DRIVE
QA Service Level1 (Verified on 03/24/2020)

Sample Information

Sample Taken Date04/05/2021 Sample Unique Key32
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 testing04/06/2021
Sample typeVerification A brief description of the sampleAsphalt Rubber Binder PG 64-16
The quantity of what the sample constitutesJMF Verification From where was the sample collectedManufacturer
First name of sampler or witnessed byGeorge Reed Personnel (SAMPLER) Last name of sampler or witnessed by Moses Onejeme (WITNESS)
Title of sampler Telephone number of sampler
Laboratory sample identificationJMF21-011 Linked DIME Sample ID
The fabricator/manufacturer/facility nameVSSE product, obtained at George Reed Inc - Clements Batch Plant Transportation Laboratory (TL) NumberC123456
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Rubber Binder Asphalt modifier supplier
Performance GradePG 64-16 Lot number
Sublot number Asphalt Rubber Binder Mix NumberNot set

JMF Information

Verification IDJMF3513-2021-50 Date Created05/06/2021
JMF Submittal IDJMF3511-23-2021-62 JMF StatusSubmittal Authorized For Use
Producer Mix ID2021-CLM-004R-VSS Authorized Date09/10/2021

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.

Sample File Attachments

File NameExtensionDate UploadedActions
No results found.

Test File Attachments