Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214899 DEA: 033H4504 EFIS: 0318000001
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-50-33.8/34.2
Work Description: CONSTRUCT RW, WIDEN RDWY, COLD PLANE AC PVMT, & HMA OVERLAY.
Location Description: EL DORADO COUNTY AT FRESH POND FROM 0.6 TO 0.2 MILE WEST OF FOREST ROAD/OUTER LIMITS LANE
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 4950 Allison Parkway, # A, Vacaville, CA 95866
Resident Engineer: Jody Phillips Structure Rep.: Dave Carlin
DIME Sample ID: 2022-10-25-33
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: 10/25/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/27/2022
The quantity of what the sample constitutes: 1 Oil Jug
A brief description of the sample: Tack Coat
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: 2022-10-25-33-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 10/31/2022
Date Tested: 10/27/2022
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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57.2 %
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Beaker 2 Residue
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56.0 %
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Percentage of residue
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57 %
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