Sample Record

Owner Lab

  • CT D03 - North Region Materials Lab

DIME Sample ID 2021-07-08-58

Project Information

Project IdentifiersProject ID: 215656
DEA: 032G0604
EFIS: 0320000192
DIST-CO-RTE-PM03-SAC-5736-
Award Date05/26/2021
Closeout DateNot set
Work DescriptionREMOVE AND REPLACE CL2 AGGREGATE BASE AND HMA (TYPE A).
Location DescriptionSACRAMENTO COUNTY IN SACRAMENTO AT THE NORTHGATE MAINTENANCE STATION AT 3940 ROSIN COURT
QA Service Level1 (Verified on 04/19/2021)

Sample Information

Sample Taken Date07/08/2021 Sample Unique Key58
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 testing07/08/2021
Sample typeVerification A brief description of the samplePG 64-16, Marathon/Western
The quantity of what the sample constitutes2 Cans From where was the sample collectedSupplier
First name of sampler or witnessed by? Last name of sampler or witnessed by?
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameMarathonWestern Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 64-16
Modified Lot number
Sublot number Tank number
Time of sample HMA Supplier
Asphalt Binder SupplierMarathon Petroleum Co. LP - Elk Grove CA MultigradeNo
Multigrade Type JMF Verification ID JMF3513-2021-79

Submitted Tests

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