DIME - Sample Record for DIME Sample ID 2022-09-01-33

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Sample Record

Owner Lab

CT HQ - Sacramento Asphalt Binder Laboratory

DIME Sample ID 2022-09-01-33

Project Information

Project Identifiers	Project ID: 993297 DEA: 010F8204 EFIS: 0116000067
DIST-CO-RTE-PM	01-HUM-101-R90.1/109.6
Award Date	01/27/2022
Closeout Date	03/04/2024
Work Description	PLACE RHMA-G AND HMA (TYPE A).
Location Description	IN HUMBOLDT COUNTY IN AND NEAR TRINIDAD FROM 1.3 MILES SOUTH OF SCHOOL ROAD OVERCROSSING TO 0.4 MILE NORTH OF BIG LAGOON BRIDGE
QA Service Level	1 (Verified on 10/12/2021)

Sample Information

Sample Taken Date	09/01/2022	Sample Unique Key	33
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	09/05/2022
Sample type	Acceptance	A brief description of the sample	Asphalt Rubber Binder PG 64-16
The quantity of what the sample constitutes	1 Can	From where was the sample collected	Fabricator
First name of sampler or witnessed by	R	Last name of sampler or witnessed by	Werner
Title of sampler	Tester	Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Mercer Fraser Fortuna Plant B	Transportation Laboratory (TL) Number	032409
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Information

Material Type	Asphalt Rubber Binder	Asphalt modifier supplier
Performance Grade	PG 64-16	Lot number
Sublot number		Asphalt Rubber Binder Mix Number	Not set

Submitted Tests

DIME Test ID	Test Method	Tester Name, Testing Lab	Date Tested	Submitted By	Verified?	Release Date	Test Comments	Actions
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