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Sample Record for 2025-06-10-3

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

Project Information

Project ID: 1000651 DEA: 010M7004 EFIS: 0123000057 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-109.55/125.73
Work Description: Orick Micro-Surfacing
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Ryan Dunne Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2025-06-10-3
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/10/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/10/2025
The quantity of what the sample constitutes: 1 canvas bag
A brief description of the sample: Type 3 Slurry Seal/Micro-surfacing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: knife river central point Oregon

Material Information

Source Identification (SMARA, name of Pit or Job Site): Knife River
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: stockpile in the Orick yard
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: 2025-06-10-3-3
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
Verified Date: 06/11/2025
Date Tested: 06/11/2025
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Sand Equivalent 80

Test 2 of 2

DIME Test ID: 2025-06-10-3-4
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 06/11/2025
Date Tested: 06/11/2025
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
What type of gradation is being tested? Combined Gradation
Cumulative percent passing the 2 in. sieve 100 %
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 84 %
Cumulative percent passing the #8 sieve 55 %
Cumulative percent passing the #16 sieve 34 %
Cumulative percent passing the #30 sieve 21 %
Cumulative percent passing the #50 sieve 14 %
Cumulative percent passing the #100 sieve 10 %
Cumulative percent passing the #200 sieve 6.7 %