Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210673 DEA: 042640F4 EFIS: 0400020132 COOP: 042308A3
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON--
Work Description:
Location Description:
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Gina Choi Structure Rep.: Brian Beaudoin
DIME Sample ID: 2021-08-31-13
TL Number from the TL Form: 745761
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: 08/31/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/01/2021
The quantity of what the sample constitutes: 1 jug. can of tack coat
A brief description of the sample: SS-1H 1jug emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GCC
DIME Test ID: 2021-08-31-13-1
Test Method: AASHTO T59-16: Standard Method of Test for Emulsified Asphalts (Emulsified Asphalt Residue Evap. (Sec. 7))
Verified Date: 09/02/2021
Date Tested: 09/01/2021
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: Per 2018 Standard Specifications
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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58.6 %
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Beaker 2 Residue
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58.4 %
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Percentage of residue
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59.0 %
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