Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994350 DEA: 070W1204 EFIS: 0721000060
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2-24.4/46.0
Work Description: SLURRY SEAL.
Location Description: LOS ANGELES COUNTY IN AND NEAR LA CANADA FLINTRIDGE AND PASADENA FROM ROUTE 2/210 SEPARATION TO 3.3 MILES EAST OF UPPER BIG TUJUNGA CANYON ROAD
Contractor Name: INTERMOUNTAIN SLURRY SEAL INC.
Contractor Address: 585 WEST BEACH STREET, WATSONVILLE CA 95076
Resident Engineer: ALIASGHAR SHALVIRI Structure Rep.: Unknown
DIME Sample ID: 2023-03-06-38
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 03/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2023
The quantity of what the sample constitutes: 2 jugs
A brief description of the sample: pmcqs-1h 2.5%
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Emulsions Inc
DIME Test ID: 2023-03-06-38-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 04/10/2023
Date Tested: 04/10/2023
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: 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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64.2 %
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Beaker 2 Residue
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64.2 %
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Percentage of residue
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64 %
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