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Sample Record for 2022-02-01-47

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

Project Information

Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50-L0.2/R6.1
Work Description: Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC
Location Description: FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: Jim Rogers Structure Rep.: Brandon Thurber

Sample Information

DIME Sample ID: 2022-02-01-47
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 02/01/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/04/2022
The quantity of what the sample constitutes: 3 bags
A brief description of the sample: 1/2 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Woodland

Material Information

Source Identification (SMARA or name of Pit): 91-34-0045
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: Manufacturer
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:

Test Results

Test 1 of 3

DIME Test ID: 2022-02-01-47-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Organization Address: 5330 Arboga Road,
Organization City: Olivehurst
Organization State: CA
Organization Zipcode: 95961
Organization Email: jeff.herbert@dot.ca.gov
Organization Phone: (530) 741-4238
Data has not been verified.

Test 2 of 3

DIME Test ID: 2022-02-01-47-3
Test Method: AASHTO T84-14: Standard Method of Test for Specific Gravity and Absorption of Fine Aggregate (Fine Specific Gravity)
Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Organization Address: 5330 Arboga Road,
Organization City: Olivehurst
Organization State: CA
Organization Zipcode: 95961
Organization Email: jeff.herbert@dot.ca.gov
Organization Phone: (530) 741-4238
Data has not been verified.

Test 3 of 3

DIME Test ID: 2022-02-01-47-4
Test Method: AASHTO T304-11: Standard Method of Test for Uncompacted Void Content of Fine Aggregate (Fine of Crushed Particles)
Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Organization Address: 5330 Arboga Road,
Organization City: Olivehurst
Organization State: CA
Organization Zipcode: 95961
Organization Email: jeff.herbert@dot.ca.gov
Organization Phone: (530) 741-4238
Data has not been verified.

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
2022-02-01-47-1AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)04/07/2022Not scheduledTerrence WhiteCT D03 - Olivehurst Northern Regional LaboratoryJeff Herbert