Sample Record for 2025-06-29-12
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995174 DEA: 043W5604 EFIS: 0421000388
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-12,80,680-Var
Work Description: POLYESTER CONCRETE OVERLAY.
Location Description: SOLANO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison ave, Sacramento, CA 95838
Resident Engineer: Justen Tatum Structure Rep.: Kambiz Kouchesfahani
Sample Information
DIME Sample ID: 2025-06-29-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2025
The quantity of what the sample constitutes: 4-Bags with Rap individual
A brief description of the sample: 3/4"HMA25%RapWMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Volcan Vallejo
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-48-0002
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: At the plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number: 1
Sublot number: 6
Aggregate Mix Number:
Test Results
Test 1 of 2
DIME Test ID: 2025-06-29-12-1
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)
Submitted By Organization: CT D04 - Concord Field Laboratory
Organization Address: 2525 Stanwell Drive, Suite 100,
Organization City: Concord
Organization State: CA
Organization Zipcode: 94520
Organization Email: gurind.joshi@dot.ca.gov
Organization Phone: (510) 714-7019
Data has not been verified.
Test 2 of 2
DIME Test ID: 2025-06-29-12-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D04 - Concord Field Laboratory
Organization Address: 2525 Stanwell Drive, Suite 100,
Organization City: Concord
Organization State: CA
Organization Zipcode: 94520
Organization Email: gurind.joshi@dot.ca.gov
Organization Phone: (510) 714-7019
Data has not been verified.
