Sample Record for 2024-05-08-59
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994532 DEA: 010E8904 EFIS: 0115000043
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101,299-88.3,0.0
Work Description: Arcata 101 Merge Improvements
Location Description: HUMBOLDT COUNTY IN ARCATA AT ROUTE 299/101 SEPARATION
Contractor Name: SHASTA SERVICES, INC. DBA TIMBERWORKS
Contractor Address: 509 S. Mt. Shasta Blvd., Mt. Shasta, CA 96067
Resident Engineer: Ryan Dunne Structure Rep.: Adlai Evans
Sample Information
DIME Sample ID: 2024-05-08-59
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 05/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/08/2024
The quantity of what the sample constitutes: 16 bags
A brief description of the sample: 1/2" aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kernen Blue Lake Plant
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-12-0012
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: at plant from conveyor belt before dryer drum
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:
Sublot number:
Aggregate Mix Number:
Test Results
Test 1 of 2
DIME Test ID: 2024-05-08-59-1
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)
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
Test 2 of 2
DIME Test ID: 2024-05-08-59-3
Test Method: AASHTO T11-5: Standard Method of Test for Materials Finer Than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
