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Sample Record for 2018-04-25-17

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

Project Information

Project ID: 212562 DEA: 024G5504 EFIS: 0214000036 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-5-2.7/R11.4
Work Description: RECONSTRUCT WITH HMA AND PCC, WIDEN STRUCTURE AND UPGRADE RAILS
Location Description: SISKIYOU COUNTY IN AND NEAR DUNSMUIR FROM SACRAMENTO RIVER BRIDGE TO 0.6 MILE SOUTH OF NORTH MOUNT SHASTA UNDERPASS
Contractor Name: J.F. SHEA CONSTRUCTION
Contractor Address: P.O. BOX 494519, REDDING, CA 96049-4519
Resident Engineer: Nicole Mallory Structure Rep.: Andrew Osullivan

Sample Information

DIME Sample ID: 2018-04-25-17
TL Number from the TL Form: C001555
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 04/25/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/29/2018
The quantity of what the sample constitutes: 1 box 4 small bags in side
A brief description of the sample: Untreated Aggregate
From where was the sample collected: Source
Laboratory sample identification: D77341
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Jt Shea-Fawndale Plant

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-45-0017
The fabricator's/manufacturer's product name for the sample: Jt Shea
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Fawndale 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: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2018-04-25-17-1
Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)
Verified Date: 07/06/2018
Date Tested: 07/06/2018
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: bang.d.nguyen@dot.ca.gov
Organization Phone: (916) 227-7204
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Size of aggregate being tested Coarse Aggregate
What type of solution was used? Sodium sulfate
What was the condition of the solution? Previously used
Number of immersion cycles performed 5
Coarse weighted average loss 1 %

Test 2 of 2

DIME Test ID: 2018-04-25-17-2
Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)
Verified Date: 07/06/2018
Date Tested: 07/06/2018
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: bang.d.nguyen@dot.ca.gov
Organization Phone: (916) 227-7204
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Size of aggregate being tested Fine Aggregate
What type of solution was used? Sodium sulfate
What was the condition of the solution? Previously used
Number of immersion cycles performed 5
Fine weighted average loss 4.5 %