Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214605 DEA: 051K7904 EFIS: 0519000026
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-166-R51.1/55.0
Work Description: COLD IN-PLACE RECYCLING AND RHMA OVERLAY.
Location Description: SANTA BARBARA COUNTY ABOUT 10 MILES WEST OF NEW CUYAMA FROM CUYAMA RIVER BRIDGE TO 3.1 MILES EAST OF COTTONWOOD CANYON ROAD
Contractor Name: Calportland Construction
Contractor Address: 1625 East Donovan Rd, Santa Maria, CA 93454
Resident Engineer: Thomas Petersen Structure Rep.: Unknown
DIME Sample ID: 2020-08-20-33
TL Number from the TL Form: 200820A-1
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: 08/20/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/02/2020
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: PASS-R emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ergon Asphalt and Emulsions
DIME Test ID: 2020-08-20-33-1
Test Method: CTM 330-September 2017: Method of Test for Residue by Evaporation of Emulsified Asphalt
Verified Date: 09/08/2020
Date Tested: 09/03/2020
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:
