Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214725 DEA: 020J1304 EFIS: 0219000064
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-139-43.0/53.0
Work Description: COLD IN-PLACE RECYCLING AND PLACE HMA (TYPE A).
Location Description: LASSEN COUNTY ABOUT 42 MILES NORTH OF SUSANVILLE FROM 3.8 MILES NORTH OF SLATE CREEK TO 4.7 MILES SOUTH OF WILLOW CREEK RANCH ROAD
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: 24339 STATE HIGHWAY 89 N.;, BURNEY CA 96013
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-07-10-25
TL Number from the TL Form: 991122
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: 07/10/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/23/2020
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: Albina
DIME Test ID: 2020-07-10-25-2
Test Method: CTM 330-September 2017: Method of Test for Residue by Evaporation of Emulsified Asphalt
Verified Date: 08/05/2020
Date Tested: 08/04/2020
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:
