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Sample Record for 2018-04-09-10

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

Project Information

Project ID: 212679 DEA: 023E7204 EFIS: 0200020154 QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-36-42.1/46.0
Work Description: COLD PLANING, PAVING, MINOR CONCRETE, ELECTRICAL AND STRIPING WORK.
Location Description: TEHAMA COUNTY IN AND NEAR RED BLUFF FROM EAST SAND SLOUGH BRIDGE TO 0.6 MILE EAST OF STICE ROAD
Contractor Name: TULLIS, INC.
Contractor Address: 16951 Clear Creek Rd., Redding, CA 96049
Resident Engineer: Anthony Granados Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2018-04-09-10
TL Number from the TL Form: T101 C852092
Sample Submitted By Organization: CT D02 - North Region Materials Lab
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 04/09/2018
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2018
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: 1/2 Cold feed and Rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77317
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Inc - Northstate Asphalt - Redding, CA

Material Information

Source Identification (SMARA or name of Pit): Unknown
The fabricator's/manufacturer's product name for the sample: Cold feed and rap
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Plant
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: Unknown
Lot number:
Sublot number:

Test Results

Test 1 of 3

DIME Test ID: 2018-04-09-10-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Submitted By Organization: CT D02 - North Region Materials Lab
Organization Address: 1657 Riverside Dr,MS-83
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: (530) 225-3194
Data has not been verified.

Test 2 of 3

DIME Test ID: 2018-04-09-10-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D02 - North Region Materials Lab
Organization Address: 1657 Riverside Dr,MS-83
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: (530) 225-3194
Data has not been verified.

Test 3 of 3

DIME Test ID: 2018-04-09-10-3
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D02 - North Region Materials Lab
Organization Address: 1657 Riverside Dr,MS-83
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: (530) 225-3194
Data has not been verified.

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.