Project Information

Project ID: 994610 DEA: 112N1204 EFIS: 1121000149 QA Service Level: 1

DIST-CO-RTE-PM: 11-SD-8,15,67-VARIOUS

Work Description: MICRO-SURFACING, COLD PLANE, OVERLAY, STRIPING, & SHOULDER BACKING.

Location Description: SAN DIEGO COUNTY AT VARIOUS LOCATIONS

Contractor Name: PAVEMENT COATINGS CO.

Contractor Address: 10240 San Sevaine Way, Jurapa Valley, CA 91752

Resident Engineer: Michael Stewart Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2023-09-20-132

TL Number from the TL Form:

Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory

Sample Organization Contact: (858) 688-1570

Type of Sample: Quality Assurance

Type of Material: Aggregate

Sample Taken Date: 09/20/2023

Date that the sample was received by the laboratory/organization performing the testing: 02/27/2024

The quantity of what the sample constitutes: 1 bag

A brief description of the sample: Type III Micro-surfacing

From where was the sample collected: Source

Laboratory sample identification: 9317-S

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: CVA

Material Information

Source Identification (SMARA, name of Pit or Job Site): N/A

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

Where the material sample would have been placed if not sampled:

Primary Aggregate Nominal Size: 3/8 inch

The concrete mix design number:

Lot number:

Sublot number:

Aggregate Mix Number:

Test Results

Test 1 of 2

DIME Test ID: 2023-09-20-132-1

Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)

Verified Date: 03/14/2024

Date Tested: 03/14/2024

Submitted By Organization: CT D11 - District 11 Materials Laboratory

Organization Address: 7177 Opportunity Road,

Organization City: San Diego

Organization State: CA

Organization Zipcode: 92111

Organization Email: dave.m.cortez@dot.ca.gov

Organization Phone: (858) 688-1570

General Comments for this Test: Test results are within specification limits.

Test Result Compliance: complies

Additional Comments When Verified:

What type of gradation is being tested?	Combined Gradation
Cumulative percent passing the 2 in. sieve	100 %
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	100 %
Cumulative percent passing the 3/8 in. sieve	100 %
Cumulative percent passing the #4 sieve	81 %
Cumulative percent passing the #8 sieve	52 %
Cumulative percent passing the #16 sieve	34 %
Cumulative percent passing the #30 sieve	23 %
Cumulative percent passing the #50 sieve	16 %
Cumulative percent passing the #100 sieve	12 %
Cumulative percent passing the #200 sieve	9.7 %

Test 2 of 2

DIME Test ID: 2023-09-20-132-2

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)