Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993505 DEA: 022J4404 EFIS: 0221000078
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-139-38.0/43.0
Work Description: REPLACE AC SURFACING, ASPHALT RUBBER BINDER, SEAL COAT & HMA OVERLAY.
Location Description: LASSEN COUNTY ABOUT 37 MILES NORTH OF SUSANVILLE FROM 4.3 MILES NORTH OF SOUTH GRASSHOPPER ROAD TO 0. 2 MILE SOUTH OF TERMO GRASSHOPPER ROAD
Contractor Name: Hat Creek Construction
Contractor Address: 24339 Highway 89 N, Burney, CA 96013
Resident Engineer: Daniel Gibbs Structure Rep.: Unknown
DIME Sample ID: 2022-09-14-65
TL Number from the TL Form: 841609
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: 09/14/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2022
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: 50/50 mix, emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina and American Pavement Systems
DIME Test ID: 2022-09-14-65-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/26/2022
Date Tested: 09/21/2022
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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31.0 %
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Beaker 2 Residue
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31.4 %
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Percentage of residue
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31 %
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