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Sample Record for 2022-11-17-72

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

Project Information

Project ID: 993559 DEA: 120R5104 EFIS: 1218000102 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-36.1
Work Description: PLACE RHMA-G AND HIGH FRICTION SURFACE TREATMENT.
Location Description: ORANGE COUNTY IN ANAHEIM AT KATELLA AVENUE UNDERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Kenneth Sham Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2022-11-17-72
TL Number from the TL Form:
Sample Submitted By Organization: CT METS QASI - Los Angeles Design Build Field Laboratory
Sample Organization Contact: (619) 204-7248
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 11/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/20/2022
The quantity of what the sample constitutes: 30 lbs
A brief description of the sample: Calcined Bauxite Agg
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: FX Minerals Processing, Inc.

Material Information

Source Identification (SMARA, name of Pit or Job Site): None
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: Sampled from truck
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:

Test Results

Test 1 of 1

DIME Test ID: 2022-11-17-72-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 12/08/2022
Date Tested: 11/20/2022
Submitted By Organization: CT METS QASI - Los Angeles Design Build Field Laboratory
Organization Address: 13230 East Firestone Boulevard, Unit D,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: eric.tsang@dot.ca.gov
Organization Phone: (619) 204-7248
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
What type of gradation is being tested? Fine Aggregate
Cumulative percent passing the 3/8 in. sieve 100 %
Cumulative percent passing the #4 sieve 100 %
Cumulative percent passing the #8 sieve 76 %
Cumulative percent passing the #16 sieve 2 %
Cumulative percent passing the #30 sieve 1 %
Cumulative percent passing the #50 sieve 0 %
Cumulative percent passing the #100 sieve 0 %
Cumulative percent passing the #200 sieve 0 %