Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2014-01-22-1160

Project Information

Project IdentifiersProject ID: 7051
DEA: 023E9304
DIST-CO-RTE-PM02-TRI,TRI-299-0.0/0.1,64.0/72.2
Award Date04/11/2012
Closeout Date06/21/2013
Work DescriptionHMA THIN BLANKET OVERLAY WITH DIGOUTS
Location DescriptionSHASTA AND TRINITY COUNTIES AT AND NEAR DOUGLAS CITY FROM 0.5 MILE EAST OF LEWISTON ROAD TO 0.1 MILE EAST OF SHASTA COUNTY LINE
QA Service Level1 (Verified on 03/29/2012)

Sample Information

Sample Taken Date01/22/2014 Sample Unique Key1160
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing01/22/2014
Sample typeInformational A brief description of the sample1/2-inch Type A aggregate extracted by ignition from HMA
The quantity of what the sample constitutes4 cores From where was the sample collectedOther
First name of sampler or witnessed byTerry Last name of sampler or witnessed byMcCormick
Title of samplerMaterials Tester Telephone number of sampler(530) 225-3414
Laboratory sample identificationD75699 / 678943 Linked DIME Sample IDNot set
The fabricator/manufacturer/facility nameTullis Inc. - Northstate Asphalt (Redding CA) Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)SMARA ID No. 91-45-0057 / MSHA Mine ID No. 0405753
The fabricator's/manufacturer's product name for the sample1/2-inch HMA Type A The fabricator/manufacturer designation for the sampleMix ID No. L120644BTR
The plant numberNot set A detailed description of where the material sample was collectedCored from in-place HMA on the roadway
Where the material sample would have been placed if not sampledNot set Primary Aggregate Nominal Size
The concrete mix design number Lot numberNot set
Sublot numberNot set HMA Design ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2014-01-22-1160-1CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse AggregatesTerry McCormickCT D02 - North Region Materials Lab02/04/2014Terry McCormick
Yes
05/21/2014Information only - not for Acceptance.