Sample Record

Owner Lab

  • Blackburn Consulting

DIME Sample ID 2023-03-08-39

Project Information

Project IdentifiersProject ID: 214469
DEA: 030H08U4
EFIS: 0319000029
DIST-CO-RTE-PM03-SAC-50-L0.2/R6.1
Award Date06/30/2020
Closeout DateNot set
Work DescriptionSac 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 DescriptionFROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
QA Service Level1 (Verified on 10/23/2019)

Sample Information

Sample Taken Date03/08/2023 Sample Unique Key39
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 testing03/08/2023
Sample typeQuality Assurance A brief description of the samplePG 64-10
The quantity of what the sample constitutes1 Sublot From where was the sample collectedSupplier
First name of sampler or witnessed bySergio Last name of sampler or witnessed byTostado
Title of samplerMaterials Tester Telephone number of sampler8315884727
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert Perkins 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 64-10
ModifiedNo Lot number1
Sublot number5 Tank number
Time of sample HMA SupplierTeichert Perkins
Certified Asphalt SupplierValero Marketing & Supply - Benicia CA MultigradeNo
Multigrade Type Asphalt Binder Mix Number

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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