Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215393 DEA: 021J5104 EFIS: 0220000086
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS,MOD-139-57.0/66.635,0.0/0.1
Work Description: PERFORM COLD IN-PLACE RECYCLING AND PLACE HOT MIX ASPHALT (TYPE A).
Location Description: LASSEN AND MODOC COUNTIES NEAR ADIN FROM 4.5 MILES SOUTH OF COUNTY ROAD A2 TO 0.1 MILE SOUTH OF ROUTE 299
Contractor Name: Hat Creek Construction
Contractor Address: 24339 Highway 89 N, Burney, CA 96013
Resident Engineer: Mike Zdenek Structure Rep.: Unknown
DIME Sample ID: 2021-08-13-30
TL Number from the TL Form: 854908
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: 08/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2021
The quantity of what the sample constitutes: 2 jugs
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: Western Emulsions Inc
DIME Test ID: 2021-08-13-30-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 08/31/2021
Date Tested: 08/30/2021
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: Per 2018 Standard Specifications
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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64.6 %
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Beaker 2 Residue
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64.4 %
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Percentage of residue
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65 %
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