Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000513 DEA: 020J8504 EFIS: 0219000168
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-89-21/R34.622
Work Description: MCCLOUD CAPM - PAVEMENT REHABILITATION
Location Description: IN SISKIYOU COUNTY AT AND NEAR MCCLOUD FROM 0.1 MILE SOUTH OF MUD CREEK BRIDGE TO ROUTE 5
Contractor Name: TULLIS, INC.
Contractor Address: Unknown
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2026-06-22-90
TL Number from the TL Form: 895739
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Production Start-Up
Type of Material: Aggregate
Sample Taken Date: 06/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/22/2026
The quantity of what the sample constitutes: Production Start-Up Evaluation
A brief description of the sample: Combined Untreated 3/4-inch Virgin Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification: D80240
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis — Northstate Asphalt (Redding, CA)
Source Identification (SMARA, name of Pit or Job Site): 91-45-0061::Latona Aggregates (Anderson, CA)_
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: Laboratory-Batched from Untreated Sized Virgin Aggregate Stockpile Samples
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:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2026-06-22-90-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
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
Data has not been verified.
