Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995285 DEA: 024H7804 EFIS: 0219000004
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-89-22.0/30.6
Work Description: PLACE HMA, SHOULDER BACKING AND THERMOPLASTIC TRAFFIC STRIPE.
Location Description: SHASTA COUNTY ABOUT 6 MILES EAST OF BURNEY FROM 0.2 MILE NORTH OF ROUTE 299 TO 0.6 MILE NORTH OF LAKE BRITTON ROAD
Contractor Name: HAT CREEK CONSTRUCTION & MATERIA02-4H7804LS, INC.
Contractor Address: Unknown
Resident Engineer: Joel Gasik Structure Rep.: Unknown
DIME Sample ID: 2024-08-06-75
TL Number from the TL Form: C035751
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: 08/06/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2024
The quantity of what the sample constitutes: 1 bottle of emulsion
A brief description of the sample: CQS-1 Emulsion
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina Asphalt - Klamath FAlls, OR
DIME Test ID: 2024-08-06-75-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 08/12/2024
Date Tested: 08/12/2024
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: 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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60.2 %
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Beaker 2 Residue
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60 %
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Percentage of residue
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60 %
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