Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215228 DEA: 060Y8004 EFIS: 0619000068 MINOR: 06A2632
QA Service Level: 1
DIST-CO-RTE-PM: 06--33,178,190,198-VAR
Work Description:
Location Description:
Contractor Name: AMERICAN PAVEMENT SYSTEMS , Inc.
Contractor Address: 1012 11th Street, Modesto, CA 95354
Resident Engineer: Amarjit Dhaliwal Structure Rep.: Unknown
DIME Sample ID: 2020-09-25-22
TL Number from the TL Form:
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: 09/25/2020
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: slurry seal type 2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: West Coast materials
DIME Test ID: 2020-09-25-22-1
Test Method: CTM 331-September 2017: Method of Test for Residue by Evaporation of Latex Modified Asphalt Emulsion
Verified Date: 10/26/2020
Date Tested: 10/14/2020
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:
