Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214190 DEA: 024G41U4 EFIS: 0218000047
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS,SIS-5-Var
Work Description: REPLACE REINFORCED CONCRETE BRIDGES & CONSTRUCT RETAINING WALL.
Location Description: SHASTA AND SISKIYOU COUNTIES ABOUT 7 MILES NORTH OF POLLARD FLAT FROM 0.8 MILE SOUTH TO 0.7 MILE NORTH OF SIMS ROAD UNDERCROSSING AND FROM 0.6 MILE SOUTH OF CASTLE CRAGS DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF SOUTH DUNSMUIR UNDERCROSSING
Contractor Name: J.F. Shea Construction, Inc.
Contractor Address: 17400 Clear Creek Road, Redding, CA 96001
Resident Engineer: Nicole Mallory Structure Rep.: Adam Scardaci
DIME Sample ID: 2020-04-08-21
TL Number from the TL Form: 897565
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 04/08/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/28/2020
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: Modified Asphalt Binder
From where was the sample collected: Distributor
Laboratory sample identification: AB206018
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Performance Grade: PG 58-34 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2020-04-08-21-1
Test Method: AASHTO T240-17: Standard Method of Test for Effect of Heat and Air on a Moving Film of Asphalt Binder (Rolling Thin-Film Oven Test)
Verified Date: 06/17/2020
Date Tested: 06/17/2020
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:
Is mass change based on one or two containers?
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One
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Any material loss from containers during heating process/testing?
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No
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Mass of empty container #1
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179.863 grams
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Mass of container #1 before test (m1i)
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215.408 grams
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Mass of container #1 after test (m1f)
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215.204 grams
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Average mass change
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-0.574 percent
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