Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212246 DEA: 053307A4 EFIS: 0514000027
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-49.7/54.6
Work Description: Cholame Segment
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Andrew Borrelli Structure Rep.: Dave Lewis
DIME Sample ID: 2023-12-05-55
TL Number from the TL Form: C979509
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Dispute Resolution
Type of Material: Aggregate
Sample Taken Date: 12/05/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/28/2023
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: 3/4 HMA-A cold feed aggregate
From where was the sample collected: Source
Laboratory sample identification: 23-Dispute-0197
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Pacific - Avenal
Source Identification (SMARA, name of Pit or Job Site): na
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 belt
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: 3
Sublot number: 12
Aggregate Mix Number: L230077A
DIME Test ID: 2023-12-05-55-1
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: 01/02/2024
Date Tested: 01/02/2024
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: bang.d.nguyen@dot.ca.gov
Organization Phone: (916) 227-7204
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
