Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214690 DEA: 060W7104
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-33-47.4/53.4,72.8/77.6
Work Description: COLD IN-PLACE RECYCLING WITH HMA (TYPE A) OVERLAY.
Location Description: FRESNO COUNTY NEAR MENDOTA AND FIREBAUGH FROM MOUNTAIN VIEW AVENUE TO ADAMS AVENUE AND FROM DOUGLAS AVENUE TO FAIRFAX AVENUE
Contractor Name: PAPICH CONSTRUCTION CO., INC.
Contractor Address: 398 SUNRISE TERRACE;, ARROYO GRANDE CA 93420
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-09-15-18
TL Number from the TL Form: 865352
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: 09/15/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/28/2020
The quantity of what the sample constitutes: 1 jar
A brief description of the sample: Asphaltic Emulsion PASS-R
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: 2020-09-15-18-1
Test Method: CTM 330-September 2017: Method of Test for Residue by Evaporation of Emulsified Asphalt
Verified Date: 10/02/2020
Date Tested: 10/02/2020
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:
