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Sample Record for 2017-11-01-18

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

Project Information

Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ
Contractor Address: 1234 address, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last

Sample Information

DIME Sample ID: 2017-11-01-18
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Control
Type of Material: Antistrip Additive
Sample Taken Date: 11/01/2017
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2017
The quantity of what the sample constitutes: 1
A brief description of the sample: for JMF QC
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mustang

Material Information

Antistrip Type: Lime Slurry
Antistrip Additive Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2017-11-01-18-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 11/01/2017
Date Tested: 11/01/2017
Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Organization Address: 5900 Folsom Boulevard, MS 5,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brett.soldano@dot.ca.gov
Organization Phone: (562) 500-5861
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
What type of gradation is being tested? HMA Gradation
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 1/4 in. sieve 100 %
Cumulative percent passing the #4 sieve 100 %
Cumulative percent passing the #8 sieve 100 %
Cumulative percent passing the #16 sieve 100 %
Cumulative percent passing the #30 sieve 99.8 %
Cumulative percent passing the #50 sieve 99.8 %
Cumulative percent passing the #100 sieve 99.8 %
Cumulative percent passing the #200 sieve 86.8 %

Test 2 of 2

DIME Test ID: 2017-11-01-18-2
Test Method: ASTM D2074-07r13: Standard Test Methods for Total, Primary, Secondary, and Tertiary Amine Values of Fatty Amines by Alternative Indicator Method (Amine)
Verified Date: 02/08/2018
Date Tested: 02/08/2018
Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Organization Address: 5900 Folsom Boulevard, MS 5,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brett.soldano@dot.ca.gov
Organization Phone: (562) 500-5861
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Amine Value 0.9
Titration S amine value of secondary and tertiary amine groups 0.8
Titration T amine value of tertiary amine groups 0.7