Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2018-04-25-17

Sample is locked from editing. info

Project Information

Project IdentifiersProject ID: 212562
DEA: 024G5504
EFIS: 0214000036
DIST-CO-RTE-PM02-SIS-5-2.7/R11.4
Award Date03/12/2018
Closeout Date10/05/2020
Work DescriptionRECONSTRUCT WITH HMA AND PCC, WIDEN STRUCTURE AND UPGRADE RAILS
Location DescriptionSISKIYOU COUNTY IN AND NEAR DUNSMUIR FROM SACRAMENTO RIVER BRIDGE TO 0.6 MILE SOUTH OF NORTH MOUNT SHASTA UNDERPASS
QA Service Level1 (Verified on 04/04/2018)

Sample Information

Sample Taken Date04/25/2018 Sample Unique Key17
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing05/29/2018
Sample typeVerification A brief description of the sampleUntreated Aggregate
The quantity of what the sample constitutes1 box 4 small bags in side From where was the sample collectedSource
First name of sampler or witnessed byDerrick Last name of sampler or witnessed byCurry
Title of samplerTech Telephone number of samplerUnknown
Laboratory sample identificationD77341 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameJt Shea-Fawndale Plant Transportation Laboratory (TL) NumberC001555
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-45-0017
The fabricator's/manufacturer's product name for the sampleJt Shea The fabricator/manufacturer designation for the sampleUnknown
The plant numberUnknown A detailed description of where the material sample was collectedFawndale Plant
Where the material sample would have been placed if not sampledUnknown Primary Aggregate Nominal Size3/4 inch
The concrete mix design numberUnknown Lot numberUnknown
Sublot numberUnknown JMF Verification ID JMF3513-2020-94
HMA PayNo

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2018-04-25-17-1AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)Bang NguyenCT HQ - Sacramento Aggregate Testing Laboratory07/06/2018Bang Nguyen
Yes
07/06/2018
2018-04-25-17-2AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)Bang NguyenCT HQ - Sacramento Aggregate Testing Laboratory07/06/2018Bang Nguyen
Yes
07/06/2018