Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-06-17-51

Project Information

Project IdentifiersProject ID: 215627
DEA: 032G2004
EFIS: 0321000024
DIST-CO-RTE-PM03-YOL-128-0.0/9.8
Award DateNot set
Closeout DateNot set
Work DescriptionPLACE RHMA AND REPLACE ASPHALT CONCRETE.
Location DescriptionYOLO COUNTY IN AND NEAR WINTERS FROM PUTAH CREEK BRIDGE TO ROUTE 128/505 SEPARATION
QA Service Level1 (Verified on 03/29/2021)

Sample Information

Sample Taken Date06/17/2021 Sample Unique Key51
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 testing07/21/2021
Sample typeVerification A brief description of the samplePG64-16 Asphalt Rubber Binder
The quantity of what the sample constitutes3 cans From where was the sample collectedSource
First name of sampler or witnessed bySam Last name of sampler or witnessed byMosallem
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameMarathon western base 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 JMF3513-2021-67

Submitted Tests

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