Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-06-30-37

Project Information

Project IdentifiersProject ID: 215572
DEA: 032G1104
EFIS: 0320000230
DIST-CO-RTE-PM03-GLE-162-66.6/76.3
Award Date05/05/2021
Closeout DateNot set
Work DescriptionPLACE RHMA AND COLD IN-PLACE RECYCLE.
Location DescriptionGLENN COUNTY IN AND NEAR WILLOWS FROM 0.2 MILE EAST OF N SHASTA STREET TO 1.0 MILE EAST OF ROAD X
QA Service Level1 (Verified on 03/22/2021)

Sample Information

Sample Taken Date06/30/2021 Sample Unique Key37
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 testing07/26/2021
Sample typeVerification A brief description of the sample1/2" RHMA-G
The quantity of what the sample constitutes2 cans From where was the sample collectedSource
First name of sampler or witnessed byBrad Last name of sampler or witnessed byMcKeehan
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameKnife River Construction - Orland Drum Plant Transportation Laboratory (TL) Number
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 JMF Verification ID JMF3513-2021-66

Submitted Tests

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