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Sample Record for 2025-09-19-26

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

Project Information

Project ID: 1000561 DEA: 010J8904 EFIS: 0119000119 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-3.9/6.0
Work Description: HOT MIX ASPHALT, AGGREGATE BASE, AND STRUCTURAL CONCRETE.
Location Description: HUMBOLDT COUNTY AT CARLOTTA FROM 0.2 MILE WEST OF FISHER ROAD TO 0.2 MILE WEST OF WILDER ROAD
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: 200 Dinsmore Dr., Fortuna, CA 95540
Resident Engineer: Cody Long Structure Rep.: Shantanu Nalawade

Sample Information

DIME Sample ID: 2025-09-19-26
TL Number from the TL Form:
Sample Submitted By Organization: BSK Associates
Sample Organization Contact: (925) 765-9483
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 09/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2025
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: 3/8 Aggregates
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pinnacle Prestress, Inc.

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-54-0021
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 @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2025-09-19-26-1
Test Method: AASHTO T11-5: Standard Method of Test for Materials Finer Than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Verified Date: 10/06/2025
Date Tested: 09/22/2025
Submitted By Organization: BSK Associates
Organization Address: 399 Lindbergh Avenue,
Organization City: Livermore
Organization State: CA
Organization Zipcode: 94551
Organization Email: cmelo@bskassociates.com
Organization Phone: (925) 765-9483
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Which test procedure is being used Method A
Percent of sample passing the #200 sieve (by mass) 1.9 %