Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215823 DEA: 101H5004 EFIS: 1017000154
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL-4-15.9/16.3
Work Description: REPLACE BRIDGE
Location Description: CALAVERAS COUNTY NEAR ANGELS CAMP FROM 0.3 MILE WEST OF CHEROKEE CREEK BRIDGE TO 0.1 MILE EAST OF CHEROKEE BRIDGE
Contractor Name: VIKING CONSTRUCTION COMPANY, INC. PM: Will Padilla
Contractor Address: P O BOX 1508, RANCHO CORDOVA, CA 95741
Resident Engineer: Elaine Yip Structure Rep.: Daniel Laureno
DIME Sample ID: 2025-10-16-19
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: 10/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2025
The quantity of what the sample constitutes: I JUG OF SS-1H
A brief description of the sample: SS-1H 80/20
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GEORGE REED CLEMENTS
DIME Test ID: 2025-10-16-19-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 10/21/2025
Date Tested: 10/21/2025
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: EVAP
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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44.8 %
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Beaker 2 Residue
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45.4 %
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Percentage of residue
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45 %
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