Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993588 DEA: 061E1004 EFIS: 0621000211
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-33,180-61.4/R62.5,23.5/24.6
Work Description: SLURRY SEAL AND MODIFY ELECTRICAL SYSTEMS.
Location Description: FRESNO COUNTY IN MENDOTA ON ROUTE 33 FROM BELMONT AVENUE TO BASS AVENUE AND ON ROUTE 180 FROM ROUTE 33 TO BELMONT AVENUE
Contractor Name: VSS International Inc.
Contractor Address: 3785 Channel Dr., West Sacramento CA, 95691
Resident Engineer: Fakhrudin Dadawalla Structure Rep.: Unknown
DIME Sample ID: 2022-06-21-27
TL Number from the TL Form: 040348
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: 06/21/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/28/2022
The quantity of what the sample constitutes: 2 jars
A brief description of the sample: Slurry Seal Oil PMCQS-1H
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VSS Emultech
DIME Test ID: 2022-06-21-27-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 07/01/2022
Date Tested: 06/30/2022
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: complies
Additional Comments When Verified:
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How many beakers will be used to conduct the test?
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2
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Beaker 1 Residue
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63.4 %
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Beaker 2 Residue
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62.8 %
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Percentage of residue
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63.0 %
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