Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214797 DEA: 031G2504 EFIS: 0318000107
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-193-19.3/R24.7
Work Description: COLD PLANE AC PAVEMENT, RHMA-G OVERLAY, & REPLACE GUARDRAIL.
Location Description: EL DORADO COUNTY NEAR PLACERVILLE FROM 0.1 MILE NORTH OF GARDEN VALLEY ROAD TO SOUTH FORK AMERICAN RIVER BRIDGE
Contractor Name: GEORGE REED INC
Contractor Address: 140 EMPIRE AVE, MODESTO CA 95354
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-08-12-3
TL Number from the TL Form: 788463
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: 08/12/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/14/2020
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: ss1h not cut 100%
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
DIME Test ID: 2020-08-12-3-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 08/17/2020
Date Tested: 08/17/2020
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard, Room 225,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (916) 227-7302
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
How many beakers will be used to conduct the test?
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4
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Beaker 1 Residue
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59.4 %
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Beaker 2 Residue
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59.4 %
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Beaker 3 Residue
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59.2 %
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Beaker 4 Residue
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59.4 %
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Percentage of residue
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59.4 %
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