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Sample Record for 2021-10-10-4

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Project Information

Project ID: 215593 DEA: 112N0954 EFIS: 1120000251 QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-8-R25.9/R32.0
Work Description: COLD PLANE, PAVE WITH RHMA, APPLY MICROSURFACING AND TRAFFIC STRIPE.
Location Description: SAN DIEGO COUNTY NEAR ALPINE FROM 0.2 MILE EAST OF HARBISON CANYON ROAD UNDERCROSSING TO 0.4 MILE EAST OF VIEJAS CREEK BRIDGE.
Contractor Name: ATP General Engineering
Contractor Address: 4211 Ponderosa Ave, Suite C, San Diego, CA 92123
Resident Engineer: Sam Barjoud Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-10-10-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/10/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2021
The quantity of what the sample constitutes: 1 qt
A brief description of the sample: MSE Emulsion
From where was the sample collected: Job Site
Laboratory sample identification: 12-485298
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Emulsions Inc

Material Information

Emulsion Grade: MSE
Lot Number:
Sub Lot:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-10-10-4-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.

Test 2 of 2

DIME Test ID: 2021-10-10-4-2
Test Method: AASHTO T59-18: Standard Method of Test for Emulsified Asphalts (Sieve Test (Sec. 13))
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.