Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212680 DEA: 024F5504 EFIS: 0213000005
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-89-20.9 - 21.2
Work Description: BRIDGE REPLACEMENT WITH PRE-CAST I-GIRDER AND RECONSTRUCT HIGHWAY
Location Description: SISKIYOU COUNTY NEAR MCCLOUD FROM 0.2 MILE SOUTH TO 0.2 MILE NORTH OF MUD CREEK BRIDGE
Contractor Name: STEELHEAD CONSTRUCTORS, INC.
Contractor Address: PO Box 997, Palo Cedro, CA 96073
Resident Engineer: Mike Zdenek Structure Rep.: Ryan Duran
DIME Sample ID: 2018-10-02-8
TL Number from the TL Form: T101 C002146
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 10/02/2018
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2018
The quantity of what the sample constitutes: PSE, 3 bags
A brief description of the sample: PSE, 3/4 Cold feed and rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77676
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis, Northstate Asphalt, Redding, CA
Source Identification (SMARA, name of Pit or Job Site): 91-45-0057
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: 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: JMF 17-05-R1
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2018-10-02-8-1
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 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
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.
DIME Test ID: 2018-10-02-8-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
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.
DIME Test ID: 2018-10-02-8-3
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
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.
