FORMS FOR SPECIFICATIONS, ETC., FOR ROAD MATERIALS. 41 
(Name and location of laboratory.) 
Report on Sample of Petkoleum 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° C./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, ° C, cm. ° C, 
Loss at 105° C, 5 hours 
Loss at 163° C, 5 hours 
Characteristics of residue 
Gonsistencv of residue/ Pentration 25 o° C " 10 ° grams ' 5 sec0n o ds 
consistency or r esiaue | Floattegtj __o (seconds) . ° G> ( seC onds) 
Total bitumen (soluble in CS a ) 
Organic matter insoluble 
Inorganic matter insoluble 
Per cent of total bitumen insoluble in 86° B. naphtha 
Fixed carbon 
Residue of penetration 
Remarks? 
Respectfully submitted, 
(Title) 
