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Sample Record for 2018-06-09-2

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

Project Information

Project ID: 212497 DEA: 024E0204 EFIS: 0200020196 QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-299-77.8/79.7
Work Description: PULVERIZE AND RECONSTRUCT PAVEMENT, AND WIDEN WITH AB, HMA, & RHMA
Location Description: SHASTA COUNTY NEAR BURNEY FROM 0.2 MILE WEST OF SONOMA STREET TO 0.3 MILE WEST OF ROUTE 89
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: 24339 Highway 89, N. Burney, CA 96013
Resident Engineer: Tofael Anwar Structure Rep.: Christopher S 'Chris' Brace

Sample Information

DIME Sample ID: 2018-06-09-2
TL Number from the TL Form: T101 C736688
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: 06/09/2018
Date that the sample was received by the laboratory/organization performing the testing: 06/09/2018
The quantity of what the sample constitutes: PSE 3 bags
A brief description of the sample: 3/4 cold feed and rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77442
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hat Creek - Shaw Pit Facility

Material Information

Source Identification (SMARA or name of Pit): 91-25-0008::SHAW PIT
The fabricator's/manufacturer's product name for the sample: PSE 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: Stockpile @ 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: 2018-06-09-2-1
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: 2018-06-09-2-2
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: 2018-06-09-2-3
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.