Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993114 DEA: 051K8504 EFIS: 0519000032
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON,SLO-1,41,227-Var
Work Description: INSTALL CENTERLINE AND EDGE LINE RUMBLE STRIP.
Location Description: MONTEREY AND SAN LUIS OBISPO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: CAL STRIPE INC.
Contractor Address: Unknown
Resident Engineer: Sandeep Gill Structure Rep.: Unknown
DIME Sample ID: 2022-04-25-18
TL Number from the TL Form: 220425
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: 04/25/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/29/2022
The quantity of what the sample constitutes: 2 jugs
A brief description of the sample: 60/40 MIX
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: 2022-04-25-18-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 05/05/2022
Date Tested: 05/05/2022
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: does not comply
Additional Comments When Verified:
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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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32 %
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Beaker 2 Residue
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32 %
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Beaker 3 Residue
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32 %
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Beaker 4 Residue
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32.2 %
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Percentage of residue
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32 %
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