Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993454 DEA: 040K8004 EFIS: 0416000141 COOP: 042892
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-13.7
Work Description: CONSTRUCT ROUNDABOUT, CURB RAMPS AND SW, SIGNAL AND LIGHTING SYSTEMS.
Location Description: MARIN COUNTY IN SAN RAFAEL AT FREITAS PARKWAY OVERCROSSING
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 JACOBY STREET, SAN RAFAEL CA 94901
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeremy Light
DIME Sample ID: 2026-05-06-55
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: 05/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/08/2026
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: tack oil
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
DIME Test ID: 2026-05-06-55-1
Test Method: AASHTO T59-25: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 05/16/2026
Date Tested: 05/14/2026
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: does not comply
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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39.6 %
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Beaker 2 Residue
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39.6 %
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Percentage of residue
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40 %
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