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Sample Record for 2025-04-15-51

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 995524 DEA: 021H3604 EFIS: 0216000040 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-76.8/78.0
Work Description: REPLACE BRIDGE.
Location Description: SISKIYOU COUNTY NEAR HORSE CREEK FROM 0.4 MILE WEST OF KLAMATH RIVER BRIDGE TO 2.0 MILES WEST OF KOHL CREEK
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Nicholas Riddle Structure Rep.: Mike Sears

Sample Information

DIME Sample ID: 2025-04-15-51
TL Number from the TL Form: 823562C
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 04/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/15/2025
The quantity of what the sample constitutes: JMF Verification and Annual Soundness Testing
A brief description of the sample: 2 bags of Dust Untreated Sized Virgin Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification: D79842C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis — Northstate Asphalt (Redding, CA)

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-45-0057::Shasta Ranch Aggregates (Anderson, CA)
The fabricator's/manufacturer's product name for the sample: Dust
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2025-04-15-51-1
Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)
Verified Date: 07/16/2025
Date Tested: 07/14/2025
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: ryan.kester@dot.ca.gov
Organization Phone: (916) 227-7215
General Comments for this Test: Due to Translab closure, sample tested at SRL
Test Result Compliance:
Additional Comments When Verified:
Size of aggregate being tested Fine Aggregate
What type of solution was used? Sodium sulfate
What was the condition of the solution? Freshly prepared
Number of immersion cycles performed 5
Fine weighted average loss 1 %

Test 2 of 2

DIME Test ID: 2025-04-15-51-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 04/22/2025
Date Tested: 04/17/2025
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: 530-225-3194
General Comments for this Test:
Test Result Compliance: not applicable
Additional Comments When Verified:
What type of gradation is being tested? HMA Gradation
Cumulative percent passing the 2 in. sieve no data
Cumulative percent passing the 1 1/2 in. sieve 100 %
Cumulative percent passing the 1 in. sieve 100 %
Cumulative percent passing the 3/4 in. sieve 100 %
Cumulative percent passing the 1/2 in. sieve 100 %
Cumulative percent passing the 3/8 in. sieve 100 %
Cumulative percent passing the #4 sieve 100 %
Cumulative percent passing the #8 sieve 72 %
Cumulative percent passing the #16 sieve 46 %
Cumulative percent passing the #30 sieve 31 %
Cumulative percent passing the #50 sieve 22 %
Cumulative percent passing the #100 sieve 15 %
Cumulative percent passing the #200 sieve 11.6 %