Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000562 DEA: 010K9404 EFIS: 0121000033
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-74.8/76.1
Work Description: LIGHTING SYSTEM, FIBER OPTIC CABLE SYSTEM, AND MINOR CONCRETE.
Location Description: HUMBOLDT COUNTY IN AND NEAR EUREKA FROM HERRICK AVENUE OVERCROSSING TO 0.1 MILE NORTH OF HIGHLAND AVENUE
Contractor Name: G R SUNDBERG, INC.
Contractor Address: Unknown
Resident Engineer: Robin Collins Structure Rep.: Adlai Evans
DIME Sample ID: 2026-05-29-25
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: 05/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/02/2026
The quantity of what the sample constitutes: 2 bottles of mse
A brief description of the sample: MSE
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Emulsions Inc
DIME Test ID: 2026-05-29-25-1
Test Method: AASHTO T59-25: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 06/08/2026
Date Tested: 06/08/2026
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: 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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63.2 %
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Beaker 2 Residue
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63 %
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Percentage of residue
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63 %
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