Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994845 DEA: 061E6104 EFIS: 0622000068
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-63-2.0/4.0
Work Description: FOR CONSTRUCTION ON STATE HIGHWAY IN TULARE COUNTY NEAR VISALIA FROM EAST CARTMILL AVENUE TO AVENUE 264
Location Description: In District 06 On Route 63
Contractor Name: AGEE CONSTRUCTION CORPORATION
Contractor Address: 1039 HOBLITT AVE, CLOVIS, CA 93612
Resident Engineer: Haidar Haddadin Structure Rep.: Unknown
DIME Sample ID: 2023-10-04-38
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: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 10/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/10/2023
The quantity of what the sample constitutes: 2 of 2 bottles
A brief description of the sample: ASPHALT EMULSION
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL INC
DIME Test ID: 2023-10-04-38-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 10/11/2023
Date Tested: 10/11/2023
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: EVAP
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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57.4 %
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Percentage of residue
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57 %
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