Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994971 DEA: 061E6204 EFIS: 0622000069
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-198-R19.7/26.7, 1.0/13.9
Work Description:
Location Description:
Contractor Name: PAVEMENT COATINGS CO.
Contractor Address: 19062 San Jose Avenue, LaPuente,CA 91748
Resident Engineer: Haidar Haddadin Structure Rep.: Unknown
DIME Sample ID: 2023-09-13-35
TL Number from the TL Form: 000000000000
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: 09/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/15/2023
The quantity of what the sample constitutes: 1 jar
A brief description of the sample: EMULSION
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL MADERA
DIME Test ID: 2023-09-13-35-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/19/2023
Date Tested: 09/19/2023
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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64.8 %
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Percentage of residue
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65 %
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