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Sample Record for 2021-10-04-5

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

Project Information

Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169 QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.4/R7.7
Work Description: Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description: 101 freeway in Summerland, CA
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Taylor Merlo Structure Rep.: Dave Lewis

Sample Information

DIME Sample ID: 2021-10-04-5
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California, LLC
Sample Organization Contact: 661-630-7162
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 10/04/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2021
The quantity of what the sample constitutes: 1020 grams
A brief description of the sample: 3/8
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan

Material Information

Source Identification (SMARA or name of Pit): SMARA 91 15 0041
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: silo
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Results

Test 1 of 1

DIME Test ID: 2021-10-04-5-1
Test Method: ASTM C117-17: Standard Test Method for Materials Finer than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Verified Date: 10/06/2021
Date Tested: 10/04/2021
Submitted By Organization: Con-Fab California, LLC
Organization Address: 701 Golds Ave,
Organization City: Shafter
Organization State: CA
Organization Zipcode: 93263
Organization Email:
Organization Phone: 661-630-7162
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Percent finer than No. 200 sieve 1 %

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.