Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214885 DEA: 080K1234 EFIS: 0815000242
QA Service Level: 1
DIST-CO-RTE-PM: 08---
Work Description:
Location Description:
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: 135 S STATE COLLEGE BLVD #400, BREA CA 92821
Resident Engineer: Taghreed Al-Khateeb Structure Rep.: Unknown
DIME Sample ID: 2020-10-28-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Hesperia Field Testing Laboratory
Sample Organization Contact: (951) 840-8242
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 10/28/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/28/2020
The quantity of what the sample constitutes: 1
A brief description of the sample: 3/4" RHMA -G AGG
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
Source Identification (SMARA, name of Pit or Job Site): Blue Diamond Oro Grande, White Mountain
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 300072 LSM LC
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2020-10-28-5-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D08 - Hesperia Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
DIME Test ID: 2020-10-28-5-2
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
Submitted By Organization: CT D08 - Hesperia Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
DIME Test ID: 2020-10-28-5-3
Test Method: AASHTO T255-0: Standard Method of Test for Total Evaporable Moisture Content of Aggregate by Drying
Submitted By Organization: CT D08 - Hesperia Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
