Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2024-06-03-33
TL Number from the TL Form: C551317
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: 06/03/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/04/2024
The quantity of what the sample constitutes: 1 Jug of Emulsion
A brief description of the sample: ss-1h emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
DIME Test ID: 2024-06-03-33-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 06/05/2024
Date Tested: 06/05/2024
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: 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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59.4 %
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Beaker 2 Residue
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59.2 %
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Percentage of residue
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59 %
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