Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994829 DEA: 034J6504 EFIS: 0323000207
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-2/7
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-05-31-7
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: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 05/31/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/01/2023
The quantity of what the sample constitutes: 1 bottle of emulsion
A brief description of the sample: SS-1H ASPHALTIC EMULSION
From where was the sample collected: Source
Laboratory sample identification: C880769
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
DIME Test ID: 2023-05-31-7-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 06/02/2023
Date Tested: 06/02/2023
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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59.0 %
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Beaker 2 Residue
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59.0 %
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Percentage of residue
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59 %
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