Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 883101 DEA: 08TEST04 EFIS: 08TEST3101
QA Service Level: 1
DIST-CO-RTE-PM: 08---
Work Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: E3101 Test Prime 88
Contractor Address: Unknown
Resident Engineer: Julien Atallah Structure Rep.: Unknown
DIME Sample ID: 2022-11-08-1
TL Number from the TL Form:
Sample Submitted By Organization: Smith-Emery SRL
Sample Organization Contact: (626) 826-0328
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 11/08/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/08/2022
The quantity of what the sample constitutes: four bags
A brief description of the sample: Manufactured Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons - Cabazon
Source Identification (SMARA, name of Pit or Job Site): 91-03-0011
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: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2022-11-08-1-1
Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)
Submitted By Organization: Smith-Emery SRL
Organization Address: 1197 North Tustin Avenue,
Organization City: Anaheim
Organization State: CA
Organization Zipcode: 92807
Organization Email: carlos@smithemerylabs.com
Organization Phone: (626) 826-0328
Data has not been verified.
