Sample Record
Owner Lab
- CT D03 - Olivehurst Northern Regional Laboratory
DIME Sample ID 2022-02-02-54
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Project Information
| Project Identifiers | Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029 |
|---|---|
| DIST-CO-RTE-PM | 03-SAC-50-L0.2/R6.1 |
| Award Date | 06/30/2020 |
| Closeout Date | Not set |
| Work Description | Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC |
| Location Description | FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE |
| QA Service Level | 1 (Verified on 10/23/2019) |
Sample Information
| Sample Taken Date | 02/02/2022 | Sample Unique Key | 54 |
|---|---|---|---|
| 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 testing | 03/03/2022 |
| Sample type | Verification | A brief description of the sample | PG64-16 Valero |
| The quantity of what the sample constitutes | 3 cans of oil | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Teichert | Last name of sampler or witnessed by | Personnel |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Teichert Quality Assurance | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Asphalt Binder | Performance Grade | PG 64-16 |
|---|---|---|---|
| Modified | Lot number | ||
| Sublot number | Tank number | ||
| Time of sample | HMA Supplier | ||
| Certified Asphalt Supplier | Valero Marketing & Supply - Benicia CA | Multigrade | No |
| Multigrade Type | Asphalt Binder Mix Number | Not set |
JMF Information
| Verification ID | JMF3513-2022-4 | Date Created | 03/25/2022 |
|---|---|---|---|
| JMF Submittal ID | JMF3511-23-2022-5 | JMF Status | Submittal Authorized For Use |
| Producer Mix ID | GC202122-SP | Authorized Date | 03/02/2022 |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||