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Sample Record for 2024-06-28-64

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 994671 DEA: 010H8004 EFIS: 0118000110 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-254-4.3/4.7
Work Description: Project Name: Myers Flat Permanent Restoration
Location Description: Bridge No. 04E0041
Contractor Name: McCullough Construction Inc.
Contractor Address: 57 Alder Grove Road, Arcata, CA 95521
Resident Engineer: Cody Long Structure Rep.: George Moore

Sample Information

DIME Sample ID: 2024-06-28-64
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Fortuna Field Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/02/2024
The quantity of what the sample constitutes: 750 Tons, Lot 1-2
A brief description of the sample: Cold Feed, Virgin 3/4-inch Type A 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): 91-12-0066
The fabricator's/manufacturer's product name for the sample: 3/4 Cold feed and rap
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: At the plant
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: 1
Sublot number: 2
Aggregate Mix Number:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2024-06-28-64-1
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: 07/10/2024
Date Tested: 07/09/2024
Submitted By Organization: CT D01 - Fortuna Field Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Sand Equivalent 66

Test 2 of 3

DIME Test ID: 2024-06-28-64-4
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 07/17/2024
Date Tested: 07/10/2024
Submitted By Organization: CT D01 - Fortuna Field Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance: not applicable
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 100 %
Cumulative percent passing the 1/2 in. sieve 84 %
Cumulative percent passing the 3/8 in. sieve 64 %
Cumulative percent passing the #4 sieve 44 %
Cumulative percent passing the #8 sieve 28 %
Cumulative percent passing the #16 sieve 18 %
Cumulative percent passing the #30 sieve 13 %
Cumulative percent passing the #50 sieve 8 %
Cumulative percent passing the #100 sieve 5 %
Cumulative percent passing the #200 sieve 3.5 %

Test 3 of 3

DIME Test ID: 2024-06-28-64-5
Test Method: AASHTO T30-19: Standard Method of Test for Mechanical Analysis of Extracted Aggregate (Mechanical Analysis)
Verified Date: 07/17/2024
Date Tested: 07/17/2024
Submitted By Organization: CT D01 - Fortuna Field Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Is an aggregate correction factor used? No
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 100 %
Cumulative percent passing the 1/2 in. sieve 100 %
Cumulative percent passing the 3/8 in. sieve 100 %
Cumulative percent passing the #4 sieve 86 %
Cumulative percent passing the #8 sieve 77 %
Cumulative percent passing the #16 sieve 59 %
Cumulative percent passing the #30 sieve 48 %
Cumulative percent passing the #50 sieve 37 %
Cumulative percent passing the #100 sieve 30 %
Cumulative percent passing the #200 sieve 24.8 %