Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994731 DEA: 040Y3004 EFIS: 0422000265
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-92-R10.4/R12.0
Work Description: COLD PLANE ASPHALT CONCRETE PAVEMENT AND OVERLAY WITH RHMA-G.
Location Description: SAN MATEO COUNTY IN AND NEAR SAN MATEO FROM 0.2 MILE WEST OF ALAMEDA DE LAS PULGAS OVERCROSSING TO 92/101 SEPARATION
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-08-24-67
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Hayward Field Laboratory
Sample Organization Contact: (510) 723-0168
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/24/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/23/2023
The quantity of what the sample constitutes: 500 Tons
A brief description of the sample: 1/2 RHMA-G
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials - Pleasanton
Source Identification (SMARA, name of Pit or Job Site): 91-01-0010
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: Where material enters the drier drum mixer
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number: 1
Sublot number: 4
Aggregate Mix Number:
DIME Test ID: 2023-08-24-67-1
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)
Verified Date: 12/22/2023
Date Tested: 08/25/2023
Submitted By Organization: CT D04 - Hayward Field Laboratory
Organization Address: 21339 Cabot Boulevard,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: pamela.brown@dot.ca.gov
Organization Phone: (510) 385-8258
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
