Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215571 DEA: 032G0904 EFIS: 0320000228
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-49-16.5/23.6
Work Description: MICRO-SURFACING.
Location Description: EL DORADO COUNTY NEAR PLACERVILLE FROM DIANA STREET TO 0.3 MILE EAST OF LOTUS ROAD
Contractor Name: VSS INTERNATIONAL, INC
Contractor Address: 6751 W Galveston St, Chandler, AZ 85226
Resident Engineer: Jody C hillips Structure Rep.: Unknown
DIME Sample ID: 2021-05-17-9
TL Number from the TL Form: 788880
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: 05/17/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/20/2021
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: Emulsion - 60/40 Diluted
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific North West
DIME Test ID: 2021-05-17-9-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 05/20/2021
Date Tested: 05/20/2021
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: 2018 per spec.
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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57.4 %
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Beaker 2 Residue
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57.4 %
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Beaker 3 Residue
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57.4 %
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Beaker 4 Residue
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55.6 %
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Percentage of residue
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56.9 %
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