Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214587 DEA: 101J1604 EFIS: 1018000180
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-132-27.9/41.0
Work Description: COLD PLANE AC PAVEMENT, RHMA OVERLAY AND SLURRY SEAL.
Location Description: STANISLAUS COUNTY IN AND NEAR WATERFORD FROM G STREET TO 1.2 MILES EAST OF RUSHING ROAD
Contractor Name: George Reed
Contractor Address: PO Box, Greenwood, CA 95635
Resident Engineer: Ranbir Bhullar Structure Rep.: Unknown
DIME Sample ID: 2020-06-30-39
TL Number from the TL Form: 828077
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: 06/30/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2020
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: Western Refining
DIME Test ID: 2020-06-30-39-1
Test Method: CTM 331-September 2017: Method of Test for Residue by Evaporation of Latex Modified Asphalt Emulsion
Verified Date: 07/27/2020
Date Tested: 07/23/2020
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:
