Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2021-06-03-17

Sample is locked from editing. info

Project Information

Project IdentifiersProject ID: 215424
DEA: 024G4404
EFIS: 0214000013
DIST-CO-RTE-PM02-SIS-3-38.0/38.6
Award Date03/22/2021
Closeout DateNot set
Work DescriptionBRIDGE REPLACEMENT
Location DescriptionSISKIYOU COUNTY ABOUT 6 MILES NORTH OF FORT JONES FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF LOWER MOFFETT CREEK ROAD
QA Service Level1 (Verified on 01/19/2021)

Sample Information

Sample Taken Date06/03/2021 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 testing06/03/2021
Sample typeAcceptance A brief description of the sampleColdfeed Lime Treated 3/4" Agg
The quantity of what the sample constitutesPSE at 395 Tons From where was the sample collectedManufacturer
First name of sampler or witnessed byD. Last name of sampler or witnessed byOwens
Title of samplerPEI Telephone number of sampler
Laboratory sample identificationD78823 Linked DIME Sample ID2021-06-03-18
The fabricator/manufacturer/facility nameTullis Inc - Northstate Asphalt - Redding, CA Transportation Laboratory (TL) Number779366
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-45-0057
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 collectedSampling device at plant
Where the material sample would have been placed if not sampled02 SIS 3 Primary Aggregate Nominal Size3/4 inch
The concrete mix design number Lot number
Sublot number HMA Design ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-06-03-17-1AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)Terry McCormickCT D02 - North Region Materials Lab06/04/2021Darrell Valasek
Yes
08/27/2021