Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213274 DEA: 010C8104 EFIS: 0113000060
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-20,53-31.1/31.8,7.0/7.4
Work Description: CONSTRUCT ROUNDABOUT
Location Description: LAKE COUNTY NEAR CLEARLAKE OAKS ON ROUTE 20 FROM 0.5 MILE WEST TO 0.2 MILE EAST OF ROUTE 53 AND ON ROUTE 53 FROM 0.4 MILE SOUTH OF ROUTE 20 TO ROUTE 20
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Dan Kraft Structure Rep.: Unknown
DIME Sample ID: 2020-06-16-21
TL Number from the TL Form: 036326
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: 06/16/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2020
The quantity of what the sample constitutes: 2 bottles
A brief description of the sample: 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 - Stockton, CA
DIME Test ID: 2020-06-16-21-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Residue and Oil Distillate (Sec. 6))
Verified Date: 06/23/2020
Date Tested: 06/23/2020
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:
Additional Comments When Verified:
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What parameters are being calculated?
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Percentage of oil residue
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Is this a polymer-modified emulsion
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No
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Percentage of oil residue
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60.2 %
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