FORMS FOR SPECIFICATIONS, ETC., FOR ROAD MATERIALS. 41 



(Name and location of laboratory:) 



Report on Sample of Petroleum or Asphalt Products. 

 (Classification name of material.) 



Laboratory No , 191 — 



(Date reported.) 



Trade name 



Identification marks 



Submitted by Title Address 



Sampled , 191__ Received , 191__ 



Sampled from 



Quantity represented 



Manufactured by 



Location used or to be used 



Examined for 



test results. 



General characteristics 



Specific gravity, 25° 0./25° C 



Flash point (° C.) _ 



Specific viscosity, Engler at ° C 



Float test, ° C, (seconds) ; ° C, (seconds) 



Penetration, 25° C, 100 grams, 5 seconds 



0° C., 200 " 60 " 



46.1° C, 50 " 5 " 



Melting point, (° C.) 



Ductility, ° 0., cm. ° C, cm. 



Loss at 105° C, 5 hours 



Loss at 163° C, 5 hours 



Characteristics of residue 



Consistencv of residue/ Pentration 25 o° °-' 10 ° S rams > 5 seconds 



consistency or residue j mQ&t ^ __o ( sec0 nds) ; ° C, (seconds) ___. 



Total bitumen (soluble in CSa) 



Organic matter insoluble 



Inorganic matter insoluble 



Per cent of total bitumen insoluble in 86° B. naphtha 



Fixed carbon . 



Residue of penetration 



Remarks: 



Respectfully submitted, 



"7Title)"~I~~-~~-~~~~~~~™ 



