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Sample Record for 2018-08-08-15

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

Project Information

Project ID: 212574 DEA: 02368414 EFIS: 0215000066 QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-44-R4.6/R6.4
Work Description: CONSTRUCT OVERCROSSING, WIDEN WITH HMA AND AB, AND OVERLAY WITH HMA
Location Description: SHASTA COUNTY NEAR PALO CEDRO FROM CLOUGH CREEK BRIDGE TO 0.6 MILE WEST OF DESCHUTES ROAD UNDERCROSSING
Contractor Name: TULLIS, INC.
Contractor Address: P O BOX 493416, REDDING CA 96049
Resident Engineer: Nathan Alexander Structure Rep.: Chaffie Eric

Sample Information

DIME Sample ID: 2018-08-08-15
TL Number from the TL Form: T101 C002196
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: 08/08/2018
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2018
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: 1/2 cold feed and rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77609
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: 1/2 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: At the 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: 2018-08-08-15-1
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: 2018-08-08-15-2
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 3 of 3

DIME Test ID: 2018-08-08-15-3
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.