Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994862 DEA: 051P5604 EFIS: 0522000082
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-1-30.0/37.5
Work Description: Overlay with rubberized hot mix asphalt - gap graded (BWC).
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SANTA CRUZ COUNTY NEAR DAVENPORT FROM 0.1 MILE SOUTH OF DAVENPORT LANDING ROAD TO SAN MATEO COUNTY LINE.
Contractor Name: PAPICH CONSTRUCTION CO., INC.
Contractor Address: 398 SUNRISE TERRACE;, ARROYO GRANDE CA 93420
Resident Engineer: Martin Jordan Structure Rep.: Unknown
DIME Sample ID: 2023-09-11-53
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2023
The quantity of what the sample constitutes: 1 2 qt jug
A brief description of the sample: BWC 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: 2023-09-11-53-4
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/26/2023
Date Tested: 09/26/2023
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: EVAP
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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63.2 %
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Beaker 2 Residue
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62.8 %
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Percentage of residue
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63 %
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DIME Test ID: 2023-09-11-53-5
Test Method: AASHTO T49-15: Standard Method of Test for Penetration of Bituminous Materials
Verified Date: 10/02/2023
Date Tested: 09/29/2023
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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Was test performed on residue from distillation or evaporation?
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Evaporation
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Temperature (C)
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25 C
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Load (grams)
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50 grams
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Time (sec)
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5 second
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Average Penetration
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75 dmm
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