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Sample Record for 2020-06-25-6

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

Project Information

Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ
Contractor Address: 1234 address, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last

Sample Information

DIME Sample ID: 2020-06-25-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 06/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/27/2020
The quantity of what the sample constitutes: 10 lb
A brief description of the sample: Dummy Aggregates
From where was the sample collected: Source
Laboratory sample identification: DummyAgg 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dummy Concrete

Material Information

Source Identification (SMARA, name of Pit or Job Site): Dummy Pit
The fabricator's/manufacturer's product name for the sample: Unknown
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: Ready Mix Concrete
Primary Aggregate Nominal Size: 1-1/2 inch
The concrete mix design number: Unknown
Lot number: 1
Sublot number: 1
Aggregate Mix Number:

Test Results

Test 1 of 3

DIME Test ID: 2020-06-25-6-1
Test Method: ASTM C136-06: Standard Test Method for Sieve Analysis of Fine and Coarse Aggregates
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.

Test 2 of 3

DIME Test ID: 2020-06-25-6-2
Test Method: ASTM C117-13: Standard Test Method for Materials Finer than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.

Test 3 of 3

DIME Test ID: 2020-06-25-6-3
Test Method: ASTM C566-13: Standard Test Method for Total Evaporable Moisture Content of Aggregate by Drying
Submitted By Organization: CT HQ - QASI Bay Area Field Office
Organization Address: 690 Walnut Avenue, Suite 150,
Organization City: Vallejo
Organization State: CA
Organization Zipcode: 94592
Organization Email: maged.g.armanuse@dot.ca.gov
Organization Phone: (916) 284-6784
Data has not been verified.