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Sample Record for 2021-06-22-8

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

Project Information

Project ID: 215424 DEA: 024G4404 EFIS: 0214000013 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3-38.0/38.6
Work Description: BRIDGE REPLACEMENT
Location Description: SISKIYOU COUNTY ABOUT 6 MILES NORTH OF FORT JONES FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF LOWER MOFFETT CREEK ROAD
Contractor Name: Steelhead Constructors
Contractor Address: 2940 INNSBRUCK DRIVE, REDDING CA 96003
Resident Engineer: Nicole Mallory Structure Rep.: Andy O'Sullivan

Sample Information

DIME Sample ID: 2021-06-22-8
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: 209-249-4700
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 06/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/22/2021
The quantity of what the sample constitutes: One proportion from top, middle and bottom of stockpile
A brief description of the sample: 1/2"x#4 rocks
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab California, LLC

Material Information

Source Identification (SMARA or name of Pit): 91-39-0029
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: One proportion from top, middle and bottom of stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 98LV25AF
Lot number:
Sublot number:

Test Results

Test 1 of 3

DIME Test ID: 2021-06-22-8-1
Test Method: ASTM C136-06: Standard Test Method for Sieve Analysis of Fine and Coarse Aggregates
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 E. Lathrop Rd.,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email:
Organization Phone: 209-249-4700
Data has not been verified.

Test 2 of 3

DIME Test ID: 2021-06-22-8-2
Test Method: ASTM D2419-09: Standard Test Method for Sand Equivalent Value of Soils and Fine Aggregate
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 E. Lathrop Rd.,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email:
Organization Phone: 209-249-4700
Data has not been verified.

Test 3 of 3

DIME Test ID: 2021-06-22-8-3
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: Con-Fab California Corporation - Lathrop
Organization Address: 1910 E. Lathrop Rd.,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email:
Organization Phone: 209-249-4700
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.