Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993193 DEA: 031H18U4 EFIS: 0321000106
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-80-13.0/16.5
Work Description: ROADWAY EXCAVATION, JPCP AND FURNISH POLYESTER CONCRETE OVERLAY.
Location Description: NEVADA COUNTY IN AND NEAR TRUCKEE FROM 0.2 MILE WEST OF DONNER PARK OVERCROSSING TO ROUTE 89/267 SEPARATION
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Randy Stellhorn Structure Rep.: Carl Anderson
DIME Sample ID: 2022-09-24-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/24/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/26/2022
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: SS-1H 1jug tack coat emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
DIME Test ID: 2022-09-24-9-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/27/2022
Date Tested: 09/27/2022
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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59.2 %
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Beaker 2 Residue
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59.4 %
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Percentage of residue
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59 %
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