Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000139 DEA: 010L9604 EFIS: 0122000068
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101,253-VAR
Work Description: POLYESTER CONCRETE OVERLAY, HMA-A, COLD PLANE ASPHALT CONCRETE. (PROJECT NAME: SOUTH AREA BRIDGE 23-24)
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: TPA CONSTRUCTION, INC.
Contractor Address: 1770 Booth Road, Roseville, CA 95747
Resident Engineer: Kassaye Seyoum Structure Rep.: Unknown
DIME Sample ID: 2025-10-02-47
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: 10/02/2025
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
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRANITE
DIME Test ID: 2025-10-02-47-1
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: 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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8.2 %
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Beaker 2 Residue
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9.4 %
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Percentage of residue
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9 %
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