Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212899 DEA: 051C6704 EFIS: 0512000194
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-17-0.2-0.5
Work Description: PASATIEMPO RETAINING WALL -
Location Description: IN SANTA CRUZ FROM 0.5 MILE TO 0.3 MILES SOUTH OF PASATIEMPO OVERCROSSING
Contractor Name: Graniterock Construction
Contractor Address: 5225 Hellyer Ave, Suite 220, San Jose, CA 95138
Resident Engineer: Bertha Roman Structure Rep.: Ann Meyer
DIME Sample ID: 2020-09-27-4
TL Number from the TL Form: 749072
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: 09/27/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/07/2020
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: Granite Rock Redwood
DIME Test ID: 2020-09-27-4-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 10/09/2020
Date Tested: 10/08/2020
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:
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How many beakers will be used to conduct the test?
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4
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Beaker 1 Residue
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57.0 %
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Beaker 2 Residue
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56.8 %
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Beaker 3 Residue
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57.0 %
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Beaker 4 Residue
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57.0 %
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Percentage of residue
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57.0 %
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