Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214554 DEA: 010H3404 EFIS: 0117000162
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-55.1/64.7
Work Description: MICRO-SURFACING AND THERMOPLASTIC DELINEATION REPLACEMENT.
Location Description: MENDOCINO COUNTY NEAR LONGVALE FROM 0.4 MILES SOUTH OF SHIMMINS RIDGE ROAD TO LONG VALLEY CREEK BRIDGE 10-0099
Contractor Name: SIERRA NEVADA CONSTRUCTION, INC
Contractor Address: 2055 EAST GREG ST;, SPARKS NV 89431
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-05-06-8
TL Number from the TL Form: NA
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 05/06/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2020
The quantity of what the sample constitutes: 2 bottles
A brief description of the sample: MSE
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Idaho Asphalt Supply, Inc
DIME Test ID: 2020-05-06-8-2
Test Method: CTM 331-September 2017: Method of Test for Residue by Evaporation of Latex Modified Asphalt Emulsion
Verified Date: 05/12/2020
Date Tested: 05/12/2020
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:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2020-05-06-8-4
Test Method: AASHTO T59-18: Standard Method of Test for Emulsified Asphalts (Sieve Test (Sec. 13))
Verified Date: 01/20/2021
Date Tested: 05/12/2020
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:
Test Result Compliance:
Additional Comments When Verified:
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Sample retained
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