Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215320 DEA: 043Q4704 EFIS: 0419000215
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-85-5.6/R17.8
Work Description: THERMOPLASTIC TRAFFIC STRIPE AND ASPHALTIC EMULSION (FOG SEAL COAT).
Location Description: SANTA CLARA COUNTY FROM GUADALUPE RIVER BRIDGE TO 0.1 MILE NORTH OF STEVENS CREEK BOULEVARD OVERCROSSING
Contractor Name: CENTRAL STRIPING SERVCICE,INC
Contractor Address: 3489 Luyung Drive, Rancho Cordova, CA 95742
Resident Engineer: Digna Dietrich Structure Rep.: Unknown
DIME Sample ID: 2022-08-23-66
TL Number from the TL Form: 927851
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: 08/23/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2022
The quantity of what the sample constitutes: 2 of 2 jugs
A brief description of the sample: fog seal emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: pacific northwest
DIME Test ID: 2022-08-23-66-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 08/30/2022
Date Tested: 08/28/2022
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:
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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25.0 %
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Beaker 2 Residue
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23.8 %
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Percentage of residue
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24 %
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