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Sample Record for 2021-08-20-59

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Project Information

Project ID: 214114 DEA: 040A5394 EFIS: 0418000244 QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80,12-11.4/12.8, 2.1/2.8
Work Description: Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location Description: I-80/I-680/Route 12 Interchange
Contractor Name: Kiewit Infrastructure West Co.
Contractor Address: 4650 Business Center Drive, Fairfield, CA 94534
Resident Engineer: Fernando Dos Santos Structure Rep.: Alejandro Lara

Sample Information

DIME Sample ID: 2021-08-20-59
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - DME / District Lab
Sample Organization Contact: (510) 507-3456
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 08/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2021
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: 4 Bags of Mixed Aggregate
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Syar Vallejo

Material Information

Source Identification (SMARA or name of Pit): 91-48-0002
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: Plant QC
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:

Test Results

Test 1 of 7

DIME Test ID: 2021-08-20-59-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 10/06/2021
Date Tested: 09/01/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
What type of gradation is being tested? HMA Gradation
Does this test use 1/4 sieve? (question for HMA Gradation Type) No
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 97.6 %
Cumulative percent passing the 1/2 in. sieve 82.8 %
Cumulative percent passing the 3/8 in. sieve 71.7 %
Cumulative percent passing the #4 sieve 45.6 %
Cumulative percent passing the #8 sieve 28.4 %
Cumulative percent passing the #16 sieve 17.5 %
Cumulative percent passing the #30 sieve 11.1 %
Cumulative percent passing the #50 sieve 7.2 %
Cumulative percent passing the #100 sieve 4.6 %
Cumulative percent passing the #200 sieve 3.2 %

Test 2 of 7

DIME Test ID: 2021-08-20-59-2
Test Method: AASHTO T84-14: Standard Method of Test for Specific Gravity and Absorption of Fine Aggregate (Fine Specific Gravity)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Bulk specific gravity 2.508
Bulk specific gravity (SSD Basis) 2.618
Apparent specific gravity 2.817
Absorption 4.4 %

Test 3 of 7

DIME Test ID: 2021-08-20-59-3
Test Method: AASHTO T85-13: Standard Method of Test for Specific Gravity and Absorption of Coarse Aggregate (Coarse Specific Gravity)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Basis for relative density testing Bulk
Specific Gravity 2.626
Absorption 2.1 %

Test 4 of 7

DIME Test ID: 2021-08-20-59-4
Test Method: AASHTO T96-02r10: Standard Method of Test for Resistance to Degradation of Small-Size Coarse Aggregate by Abrasion and Impact in the Los Angeles Machine (Los Angeles Rattler)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Grading designation B
Mass of sample on No.12 sieve (after 500 revolutions) 4264 grams
Percent loss after 100 revolutions 4 %
Percent loss after 500 revolutions 15 %

Test 5 of 7

DIME Test ID: 2021-08-20-59-5
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)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Sand Equivalent 63

Test 6 of 7

DIME Test ID: 2021-08-20-59-6
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of tests 2
Mass Determination Air
Specific Gravity for Sample 1 2.457
Specific Gravity for Sample 2 2.457
Average Specific Gravity 2.457

Test 7 of 7

DIME Test ID: 2021-08-20-59-7
Test Method: AASHTO T304-11: Standard Method of Test for Uncompacted Void Content of Fine Aggregate (Fine of Crushed Particles)
Verified Date: 10/06/2021
Date Tested: 09/08/2021
Submitted By Organization: CT D04 - DME / District Lab
Organization Address: 21339 Cabot Blvd,
Organization City: Hayward
Organization State: CA
Organization Zipcode: 94545
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 507-3456
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
What test method is performed? Method A
Bulk dry specific gravity 2.508
Average uncompacted voids 45 %

Tests Assigned to this Sample

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