Sample Record

Owner Lab

  • CT HQ - Sacramento Asphalt Binder Laboratory

DIME Sample ID 2021-06-29-37

Project Information

Project IdentifiersProject ID: 212496
DEA: 024E4504
EFIS: 0200020286
DIST-CO-RTE-PM02-LAS,MOD-139,299-VAR
Award Date07/28/2020
Closeout Date08/14/2023
Work DescriptionPLACE HMA, REPLACE DRAINAGE, CULVERT, ELECTRICAL AND LIGHTING SYSTEMS.
Location DescriptionLASSEN AND MODOC COUNTIES ON ROUTE 139 AT 0.1 MILE NORTH OF LASSEN COUNTY LINE AND ON ROUTE 299 AT VARIOUS LOCATONS FROM 0.4 MILE WEST OF BOYD HILL LOOKOUT ROAD TO 0.6 MILE EAST OF COUNTY ROAD 87
QA Service Level1 (Verified on 06/06/2017)

Sample Information

Sample Taken Date06/29/2021 Sample Unique Key37
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing07/08/2021
Sample typeDepartment Acceptance A brief description of the sampleNO Test
The quantity of what the sample constitutes1 OF 2 cans From where was the sample collectedSource
First name of sampler or witnessed byE Last name of sampler or witnessed byChavez
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameAlbina - Klamath Falls, OR Transportation Laboratory (TL) Number854851
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 58-34 M
ModifiedYes Lot number
Sublot number Tank number
Time of sample HMA Supplier
Certified Asphalt SupplierAlbina Asphalt - Klamath Falls Plant - Klamath Falls OR MultigradeNo
Multigrade Type Asphalt Binder Mix NumberNot set

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments