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Sample Record for 2018-05-04-13

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

Project Information

Project ID: 212996 DEA: 023H1404 QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI,SHA-36-0.0/R3.5,0.0/4.0
Work Description: AC OVERLAY, REPLACE AC SURFACE, GUARDRAIL, SHOULDER BACKING
Location Description: SHASTA AND TRINITY COUNTIES FROM TRINITY COUNTY LINE TO 0.4 MILE EAST OF HARRISON GULCH ROAD AND FROM HUMBOLDT COUNTY LINE TO 0.2 MILE EAST OF MAD RIVER ROAD
Contractor Name: TULLIS, INC.
Contractor Address: Unknown
Resident Engineer: MANDHIR GREWAL Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2018-05-04-13
TL Number from the TL Form: T101 C896055
Sample Submitted By Organization: CT D02 - North Region Materials Lab
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 05/04/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/04/2018
The quantity of what the sample constitutes: PSE 6 bags
A brief description of the sample: PSE Cold feed and rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77349
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Northstate Asphalt

Material Information

Source Identification (SMARA or name of Pit): unknown
The fabricator's/manufacturer's product name for the sample: 3/4 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: 3/4 inch
The concrete mix design number: Unknown
Lot number:
Sublot number:

Test Results

Test 1 of 3

DIME Test ID: 2018-05-04-13-1
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 2 of 3

DIME Test ID: 2018-05-04-13-2
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: 2018-05-04-13-3
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.

Tests Assigned to this Sample

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