Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001030 DEA: 010N8204 EFIS: 0124000115
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-29-23.6/33.1
Work Description: MICRO-SURFACING, REPLACE AC SURFACING, AND DELINEATION.
Location Description: LAKE COUNTY NEAR KELSEYVILLE FROM 3.23 MILES NORTH OF SEIGLER CREEK BRIDGE TO COLE CREEK ROAD
Contractor Name: DOOLITTLE CONSTRUCTION, LLC DBA DOOLITTLE ROAD CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Dan Kraft Structure Rep.: Unknown
DIME Sample ID: 2025-09-14-10
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: 09/14/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2025
The quantity of what the sample constitutes: 1 jugs
A brief description of the sample: MSE
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Talley Oil Co
DIME Test ID: 2025-09-14-10-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 10/02/2025
Date Tested: 10/01/2025
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: not applicable
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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63.8 %
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Beaker 2 Residue
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63.8 %
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Percentage of residue
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64 %
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