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Sample Record for 2023-09-18-55

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

Project Information

Project ID: 215648 DEA: 010L0404 EFIS: 0121000044 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-12.0/16.5, 12.0-16.5
Work Description: Slide repair
Location Description:
Contractor Name: GR Sundberg Inc.
Contractor Address: 5211 Boyd Road, Arcata CA, 95521
Resident Engineer: Clayton Malmberg Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2023-09-18-55
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 09/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2023
The quantity of what the sample constitutes: 750
A brief description of the sample: 1/2 HMA AGGREGATE
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-264
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tidewater

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-08-0002
The fabricator's/manufacturer's product name for the sample: L191742
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Cold Feed
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 on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2023-09-18-55-1
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: 09/22/2023
Date Tested: 09/22/2023
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Sand Equivalent 68

Test 2 of 2

DIME Test ID: 2023-09-18-55-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Verified Date: 09/22/2023
Date Tested: 09/22/2023
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test: Combined Grading including RAP
Test Result Compliance: complies
Additional Comments When Verified:
What type of gradation is being tested? HMA Gradation
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 100 %
Cumulative percent passing the 1/2 in. sieve 97 %
Cumulative percent passing the 3/8 in. sieve 82 %
Cumulative percent passing the #4 sieve 48 %
Cumulative percent passing the #8 sieve 34 %
Cumulative percent passing the #16 sieve 24 %
Cumulative percent passing the #30 sieve 16 %
Cumulative percent passing the #50 sieve 11 %
Cumulative percent passing the #100 sieve 8 %
Cumulative percent passing the #200 sieve 5.5 %