Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214593 DEA: 09363704 EFIS: 0914000030
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-168-16.0/17.7
Work Description: PLACE MICRO-SURFACING AND STRIPING AND SIGNAL WORK.
Location Description: INYO COUNTY NEAR BISHOP FROM MEADOW LANE TO PIONEER LANE
Contractor Name: Intermountain Slurry Seal, Inc.
Contractor Address: 1120 Terminal Way, Reno , NV,89502
Resident Engineer: Damon Cherenzia Structure Rep.: Unknown
DIME Sample ID: 2020-07-28-31
TL Number from the TL Form: 664483
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: 07/28/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/07/2020
The quantity of what the sample constitutes: 1 jar
A brief description of the sample: micro surfacing emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Emulsions Inc
DIME Test ID: 2020-07-28-31-1
Test Method: CTM 331-September 2017: Method of Test for Residue by Evaporation of Latex Modified Asphalt Emulsion
Verified Date: 08/12/2020
Date Tested: 08/12/2020
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:
