Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993504 DEA: 010K9604 EFIS: 0121000036
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20-17.3/26.0
Work Description: REMOVE AND PLACE THERMOPLASTIC TRAFFIC STRIPE WITH MICRO-SURFACING.
Location Description: MENDOCINO COUNTY ABOUT 8 MILES WEST OF WILLITS FROM CHAMBERLAIN CREEK BRIDGE TO 0.3 MILE WEST OF IRMULCO ROAD
Contractor Name: VSS INTERNATIONAL INC.
Contractor Address: Unknown
Resident Engineer: Mehrdad (Mardi) Pakandam Structure Rep.: Unknown
DIME Sample ID: 2022-06-17-38
TL Number from the TL Form: 750505
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: 06/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2022
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: Emulsion
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VSS Emultech West Sac
DIME Test ID: 2022-06-17-38-1
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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64.6 %
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Beaker 2 Residue
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64.6 %
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Percentage of residue
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65.0 %
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