Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214322 DEA: 021H74U4 EFIS: 0218000043
QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-36-87.8/89.1
Work Description: CURVE REALIGNMENT AND EXTENDING THE TRUCK CLIMBING LANE.
Location Description: TEHAMA COUNTY NEAR MINERAL FROM 0.1 MILE TO 1.5 MILES EAST OF ROUTE 89
Contractor Name: STEVE MANNING CONSTRUCTION, INC
Contractor Address: 5211 Churn Creek Road, Redding, CA 96002
Resident Engineer: Tofael Anwar Structure Rep.: Unknown
DIME Sample ID: 2020-07-01-26
TL Number from the TL Form: 854829
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: 07/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/14/2020
The quantity of what the sample constitutes: 1 jug
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: 2020-07-01-26-1
Test Method: CTM 331-September 2017: Method of Test for Residue by Evaporation of Latex Modified Asphalt Emulsion
Verified Date: 07/15/2020
Date Tested: 07/15/2020
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:
