Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995183 DEA: 010M0204 EFIS: 0122000076
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-175-
Work Description:
Location Description:
Contractor Name: AMERICAN PAVEMENT SYSTEMS, Inc.
Contractor Address: 1012 11th Street, Modesto, CA 95354
Resident Engineer: Dan Kraft Structure Rep.: Unknown
DIME Sample ID: 2024-06-12-84
TL Number from the TL Form: C881507
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/17/2024
The quantity of what the sample constitutes: 1/ 2 gallon of emulsion
A brief description of the sample: Slurry Seal
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
DIME Test ID: 2024-06-12-84-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 06/19/2024
Date Tested: 06/18/2024
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 %
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Beaker 2 Residue
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64 %
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Percentage of residue
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64 %
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