Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995117 DEA: 010L3704 EFIS: 0121000103
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-254-0.2/16.8
Work Description:
Location Description:
Contractor Name: Mercer-Fraser Company
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Tai Morgan-Marbet Structure Rep.: Unknown
DIME Sample ID: 2023-08-04-75
TL Number from the TL Form: 930382
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Control
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/01/2023
The quantity of what the sample constitutes: 1 Jug
A brief description of the sample: 1 Jug PMCRS-2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
DIME Test ID: 2023-08-04-75-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/07/2023
Date Tested: 09/06/2023
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:
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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64.8 %
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Percentage of residue
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65 %
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