Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994401 DEA: 09379304 EFIS: 0919000007
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-127-21.0/34.5,41.8/49.4
Work Description: PARTIAL DEPTH RECYCLE AND HOT MIX ASPHALT (TYPE A).
Location Description: INYO COUNTY NEAR SHOSHONE FROM 4.6 MILES NORTH OF ROUTE 178 WEST TO 7.6 MILES SOUTH OF ROUTE 190 AND FROM 0.3 MILE SOUTH OF ROUTE 190 TO NEVADA STATE LINE
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-04-33
TL Number from the TL Form: 995429
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: 04/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2023
The quantity of what the sample constitutes: 1 jug
A brief description of the sample: emulsion PDR
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ergon Asphalt and Emulsion
DIME Test ID: 2023-04-04-33-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 04/17/2023
Date Tested: 04/14/2023
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 %
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