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Sample Record for 2021-06-25-13

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

Project Information

Project ID: 215624 DEA: 020J4004 EFIS: 0219000115 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-161-17.5/18.5
Work Description: FULL DEPTH RECLAMATION - CEMENT AND PLACE HMA.
Location Description: SISKIYOU COUNTY NEAR TULELAKE FROM 0.3 MILE EAST OF MALONE ROAD TO 1.2 MILES EAST OF HILL ROAD
Contractor Name: Hat Creek Construction
Contractor Address: 24339 Highway 89 N, Burney, CA 96013
Resident Engineer: Austin Henry Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-06-25-13
TL Number from the TL Form: 990939
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 06/25/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2021
The quantity of what the sample constitutes: PSE 2 Bags at 280 Tons
A brief description of the sample: Coldfeed 3/4" Lime Treated Agg
From where was the sample collected: Manufacturer
Laboratory sample identification: D78868
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hat Creek Construction and Materials - Shaw Pit Facility - 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: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Sample Device
Where the material sample would have been placed if not sampled: 02 SIS 161
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: Not Applicable
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2021-06-25-13-1
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.