Project Information

Project ID: 212496 DEA: 024E4504 EFIS: 0200020286 QA Service Level: 1

DIST-CO-RTE-PM: 02-LAS,MOD-139,299-VAR

Work Description: PLACE HMA, REPLACE DRAINAGE, CULVERT, ELECTRICAL AND LIGHTING SYSTEMS.

Location Description: LASSEN AND MODOC COUNTIES ON ROUTE 139 AT 0.1 MILE NORTH OF LASSEN COUNTY LINE AND ON ROUTE 299 AT VARIOUS LOCATONS FROM 0.4 MILE WEST OF BOYD HILL LOOKOUT ROAD TO 0.6 MILE EAST OF COUNTY ROAD 87

Contractor Name: PAR ELECTRICAL CONTRACTORS INC

Contractor Address: 1465 WEST FOURTH STREET, RENO, NV 89503

Resident Engineer: Mike Zdenek Structure Rep.: Chris Brace

Sample Information

DIME Sample ID: 2021-04-13-29

TL Number from the TL Form: 858618

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: 04/13/2021

Date that the sample was received by the laboratory/organization performing the testing: 04/14/2021

The quantity of what the sample constitutes: JMF Verification

A brief description of the sample: Crusher Dust Sized Untreated Aggregate

From where was the sample collected: Source

Laboratory sample identification: D78777C

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Shaw Pit - Lookout, CA

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-25-0008

The fabricator's/manufacturer's product name for the sample:

The fabricator/manufacturer designation for the sample:

The plant number:

A detailed description of where the material sample was collected: Stockpile

Where the material sample would have been placed if not sampled:

Primary Aggregate Nominal Size: 1/4 inch

The concrete mix design number: JMF21-03-S01

Lot number:

Sublot number:

Aggregate Mix Number:

Test Results

Test 1 of 2

DIME Test ID: 2021-04-13-29-1

Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)

Verified Date: 06/08/2021

Date Tested: 04/14/2021

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

General Comments for this Test:

Test Result Compliance:

Additional Comments When Verified:

What type of gradation is being tested?	HMA Gradation
Cumulative percent passing the 1 1/2 in. sieve	100 %
Cumulative percent passing the 1 in. sieve	100 %
Cumulative percent passing the 3/4 in. sieve	100 %
Cumulative percent passing the 1/2 in. sieve	100 %
Cumulative percent passing the 3/8 in. sieve	100 %
Cumulative percent passing the 1/4 in. sieve	100 %
Cumulative percent passing the #4 sieve	89.8 %
Cumulative percent passing the #8 sieve	54.4 %
Cumulative percent passing the #16 sieve	35 %
Cumulative percent passing the #30 sieve	24.5 %
Cumulative percent passing the #50 sieve	18.5 %
Cumulative percent passing the #100 sieve	14.7 %
Cumulative percent passing the #200 sieve	11.92 %

Test 2 of 2

DIME Test ID: 2021-04-13-29-2

Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)

Verified Date: 07/01/2021

Date Tested: 07/01/2021

Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory

Organization Address: 5900 Folsom Boulevard,

Organization City: Sacramento