Project Information

Project ID: 993333 DEA: 04264724 EFIS: 0419000068 QA Service Level: 1

DIST-CO-RTE-PM: 04-MRN-101-R20.8/27.1

Work Description: CIP BRIDGES, CONSTRUCT ROADWAY, RETAINING WALLS AND MODIFY ELECTRICAL.

Location Description: MARIN COUNTY IN AND NEAR NOVATO FROM 0.1 MILE SOUTH OF FRANKLIN AVENUE OVERHEAD TO 0.5 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE

Contractor Name: GHILOTTI CONSTRUCTION CO. INC. (RILEY GENAZZI & JOSH SERAFINO)

Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407

Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light

Sample Information

DIME Sample ID: 2023-04-13-60

TL Number from the TL Form:

Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory

Sample Organization Contact: (510) 385-6841

Type of Sample: Quality Assurance

Type of Material: Aggregate

Sample Taken Date: 04/13/2023

Date that the sample was received by the laboratory/organization performing the testing: 04/13/2023

The quantity of what the sample constitutes: 1 bag

A brief description of the sample: 3/4 HMA-SP Type A

From where was the sample collected: Manufacturer

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Dutra San Rafael

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-21-0008

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: HMA Plant Cold Feed Conveyor

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: 4

Sublot number: 11

Aggregate Mix Number:

Test Results

Test 1 of 2

DIME Test ID: 2023-04-13-60-1

Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)

Verified Date: 05/09/2023

Date Tested: 04/13/2023

Submitted By Organization: CT D04 - Petaluma Field Laboratory

Organization Address: 5675 Gibraltar Drive,

Organization City: Pleasanton

Organization State: CA

Organization Zipcode: 94588

Organization Email: glenn.cea@dot.ca.gov

Organization Phone: (510) 385-6841

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	98 %
Cumulative percent passing the 1/2 in. sieve	87 %
Cumulative percent passing the 3/8 in. sieve	71 %
Cumulative percent passing the #4 sieve	47 %
Cumulative percent passing the #8 sieve	29 %
Cumulative percent passing the #16 sieve	19 %
Cumulative percent passing the #30 sieve	13 %
Cumulative percent passing the #50 sieve	9 %
Cumulative percent passing the #100 sieve	6 %
Cumulative percent passing the #200 sieve	3.9 %

Test 2 of 2

DIME Test ID: 2023-04-13-60-2

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)