Sample Record

Owner Lab

  • CT D03 - Olivehurst Northern Regional Laboratory

DIME Sample ID 2021-04-12-68

Project Information

Project IdentifiersProject ID: 215033
DEA: 033H6504
EFIS: 0318000027
DIST-CO-RTE-PM03-NEV-49-8.3/8.7
Award Date08/07/2020
Closeout Date09/23/2021
Work DescriptionCONSTRUCT A TWO-WAY LEFT-TURN LANE AND 8' SHOULDERS.
Location DescriptionNEVADA COUNTY ON ROUTE 49 FROM 0.1 MILE SOUTH OF ROUND VALLEY ROAD TO 0.1 MILE NORTH OF QUAIL CREEK DRIVE
QA Service Level1 (Verified on 06/22/2020)

Sample Information

Sample Taken Date04/12/2021 Sample Unique Key68
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 testing04/13/2021
Sample typeVerification A brief description of the samplePG 64-16 Asphalt Binder
The quantity of what the sample constitutes3 cans From where was the sample collectedDistributor
First name of sampler or witnessed byKRC Personnel (SAMPLER) Last name of sampler or witnessed byThao Xiong (WITNESS)
Title of samplerUnknown Telephone number of samplerUnknown
Laboratory sample identificationJMF21-022 Linked DIME Sample ID
The fabricator/manufacturer/facility nameKnife River Construction - Hallwood Transportation Laboratory (TL) NumberC779131
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 64-16
ModifiedYes Lot number
Sublot number Tank numberUnknown
Time of sampleUnknown HMA SupplierKnife River Construction - Hallwood
Asphalt Binder SupplierValero Marketing & Supply - Benicia CA MultigradeNo
Multigrade Type Asphalt Binder Mix NumberNot set

JMF Information

Verification IDJMF3513-2021-62 Date Created06/21/2021
JMF Submittal IDJMF3511-23-2021-79 JMF StatusSubmittal Authorized For Use
Producer Mix IDHR-22771000V Authorized Date09/10/2021

Submitted Tests

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