Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001092 DEA: 021K1004 EFIS: 0224000051
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-97-29.0/34.5
Work Description: PLACE AR CHIP SEAL AND SLURRY SEAL.
Location Description: SISKIYOU COUNTY ABOUT 11 MILES SOUTH OF MACDOEL FROM 1.2 MILES NORTH OF TENNANT ROAD TO 1.7 MILES SOUTH OF BALL MOUNTAIN ROAD
Contractor Name: VSS INTERNATIONAL, INC.
Contractor Address: Unknown
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2025-09-04-58
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/04/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2025
The quantity of what the sample constitutes: 2 jugs
A brief description of the sample: PMCQS-1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VSS Emultech Redding
DIME Test ID: 2025-09-04-58-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/24/2025
Date Tested: 09/24/2025
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (530) 713-6823
General Comments for this Test: Evaporation
Test Result Compliance: complies
Additional Comments When Verified:
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How many beakers will be used to conduct the test?
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2
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Beaker 1 Residue
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63.6 %
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Beaker 2 Residue
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63.6 %
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Percentage of residue
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64 %
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