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Sample Record for 2024-07-22-71

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

Project Information

Project ID: 994857 DEA: 010H6104 EFIS: 0117000241 QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-13.5/R36.1
Work Description: COLD PLANE AND OVERLAY HMA, & REPLACE GUARDRAILS.
Location Description: HUMBOLDT COUNTY AT AND NEAR BRIDGEVILLE FROM 3.4 MILES WEST OF GRIZZLY CREEK BRIDGE TO 0.8 MILE EAST OF SOUTH FORK VAN DUZEN RIVER
Contractor Name: MERCER FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Joaquin Rodriquez Structure Rep.: Shantanu Nalawade

Sample Information

DIME Sample ID: 2024-07-22-71
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: 07/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2024
The quantity of what the sample constitutes: 750 Tons, Lot 1, Sublot 2
A brief description of the sample: 1/2" HMA Type A w/ 24% RAP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer-Fraser — Plant B (Fortuna, CA)

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-12-0002
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: Feed Belt
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: 2
Aggregate Mix Number:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2024-07-22-71-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 07/31/2024
Date Tested: 07/31/2024
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:
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 97 %
Cumulative percent passing the 3/8 in. sieve 87 %
Cumulative percent passing the #4 sieve 58 %
Cumulative percent passing the #8 sieve 40 %
Cumulative percent passing the #16 sieve 28 %
Cumulative percent passing the #30 sieve 21 %
Cumulative percent passing the #50 sieve 15 %
Cumulative percent passing the #100 sieve 9 %
Cumulative percent passing the #200 sieve 5.4 %

Test 2 of 3

DIME Test ID: 2024-07-22-71-2
Test Method: AASHTO T30-19: Standard Method of Test for Mechanical Analysis of Extracted Aggregate (Mechanical Analysis)
Verified Date: 07/31/2024
Date Tested: 07/31/2024
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 75 %
Cumulative percent passing the #8 sieve 54 %
Cumulative percent passing the #16 sieve 40 %
Cumulative percent passing the #30 sieve 31 %
Cumulative percent passing the #50 sieve 23 %
Cumulative percent passing the #100 sieve 16 %
Cumulative percent passing the #200 sieve 11.9 %

Test 3 of 3

DIME Test ID: 2024-07-22-71-3
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: 07/31/2024
Date Tested: 07/31/2024
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 65