QUESTIONNAIRE

EVALUATION OF HIGH PERFORMANCE BITUMINOUS PREMIX

 

1.    Producer:                                                                                      Contract No.:

 

2.   Date Received:                                                                             Location:

 

3.    Condition of material at time of delivery:

 

A.    Quantity Received:

 

B.   Did material contain ice crystals or water?                                        Y          N

 

1)    If so, how much?  (Circle number 1-5 below.)

 

Insignificant Amount - 1     2      3      4      5    - Highly Significant Amount

 

C.  Was material contaminated?                                                              Y          N

 

1)    If so, with what?

 

a)    Dust

b)    Limestone

c)    Sand

d)    Other (Specify):

e)    Unknown (Describe):

 

D.  Did material contain lumps?                                                               Y          N

 

1)    If so, how much?  (Circle number 1-5 below.)

 

Insignificant Amount - 1     2      3      4      5    - Highly Significant Amount

 

E.   Was material fully coated with a shiny black appearance?               Y          N

 

1)    If not, describe condition.

 

4.    Storage of Material

 

A.    How was material stockpiled?

 

B.   Was stockpile kept covered?                                                             Y          N

 

1)    If yes, how?

 

C.  Did a hard crust form on the stockpile?                                             Y          N

 

1)    If yes, how thick was the crust?

 

D.  Did material change appearance?  (For example, change from shiny black to dull brown?)

 

                                                                                                                  Y          N

1)    If yes, describe change in appearance.

 

E.   How long was material in stockpile before use?

 

5.    Performance of Material

 

A.   Was material usable in cold weather?                                                Y          N

 

1)    Approximately, in what temperature range was it used?

 

B.   Did material stick in patch area?                                                        Y          N

 

1)    Was patch area wet or dry?

 

C.  Did material stay put under traffic?                                                    Y          N

 

1)   If not, did material:

 

a)    Track bituminous oil

b)    Crumble and scatter

c)    “Pop out” of patch in large chunks

d)    Deform or move

 

D.  Was material heated or warmed prior to use?                                   Y          N

 

1)    If yes, how?

 

E.    Overall performance rating (Circle number 1-5 below.)

 

Very Poor     Poor      Average      Good      Excellent

1                2             3                  4               5

 

F.   Comments