Project Information

Project ID: 993608 DEA: 081H8204 EFIS: 0817000138 QA Service Level: 1

DIST-CO-RTE-PM: 08-SBD-15,138-R21.6,R14.8/R15.1

Work Description: SIGNAL AND LIGHTING SYSTEM, HMA, JPCP, AND ROADWAY EXCAVATION.

Location Description: SAN BERNARDINO COUNTY IN PHELAN ON ROUTE 138 FROM 0.3 MILE WEST OF ROUTE 138/15 SEPARATION TO ROUTE 138/15 SEPARATION AND ON ROUTE 15 SOUTHBOUND EXIT RAMP AT ROUTE 138

Contractor Name: EVERLEVEL HOLDINGS, LLC

Contractor Address: 5877 PINE AVE. SUITE 240, CHINO HILLS, CA 91709

Resident Engineer: Vu Thanh Nguyen Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2023-06-23-38

TL Number from the TL Form:

Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory

Sample Organization Contact: 9512323690

Type of Sample: Department Acceptance

Type of Material: Aggregate

Sample Taken Date: 06/23/2023

Date that the sample was received by the laboratory/organization performing the testing: 06/24/2023

The quantity of what the sample constitutes: 1 Bag from each bin: 3/4", 1/2", 3/8", & Sand

A brief description of the sample: 3/4" HMA-A R15

From where was the sample collected: Manufacturer

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Vulcan Oro Grande

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-36-0022/91-36-0046/91-36-00137

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: Conveyor Belt

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: 224112A ORO SJR

Test Results

Test 1 of 2

DIME Test ID: 2023-06-23-38-1

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

Verified Date: 07/05/2023

Date Tested: 06/28/2023

Submitted By Organization: CT D08 - Fontana Field Testing Laboratory

Organization Address: 13970 Victoria Street,

Organization City: Fontana

Organization State: CA

Organization Zipcode: 92336

Organization Email: prakash.gowda@dot.ca.gov

Organization Phone: (951) 232-3690

General Comments for this Test:

Test Result Compliance: complies

Additional Comments When Verified:

What type of gradation is being tested?	HMA Gradation
Cumulative percent passing the 2 in. sieve	no data
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	94 %
Cumulative percent passing the 1/2 in. sieve	80 %
Cumulative percent passing the 3/8 in. sieve	67 %
Cumulative percent passing the #4 sieve	56 %
Cumulative percent passing the #8 sieve	41 %
Cumulative percent passing the #16 sieve	31 %
Cumulative percent passing the #30 sieve	23 %
Cumulative percent passing the #50 sieve	16 %
Cumulative percent passing the #100 sieve	10 %
Cumulative percent passing the #200 sieve	5.3 %

Test 2 of 2

DIME Test ID: 2023-06-23-38-2

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)