Sample Record

Owner Lab

  • Blackburn Consulting

DIME Sample ID 2023-04-19-13

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 Date04/19/2023 Sample Unique Key13
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 testing04/19/2023
Sample typeQuality Control A brief description of the sampleHMA Oil
The quantity of what the sample constitutes1 Oil Can From where was the sample collectedSource
First name of sampler or witnessed byRobert Last name of sampler or witnessed bySears
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert 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
Certified Asphalt SupplierPacific Northwest Oil - Stockton 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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Sample File Attachments

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Test File Attachments