Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2021-06-02-40

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 Date06/02/2021 Sample Unique Key40
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 testing06/02/2021
Sample typeQuality Control A brief description of the sample3/8 inch lime treated aggregate
The quantity of what the sample constitutesJMF From where was the sample collectedManufacturer
First name of sampler or witnessed byC. Last name of sampler or witnessed byBryant
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameTullis Inc Shasta Ranch Agg Anderson Ca Transportation Laboratory (TL) Number
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 collectedPlant
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size3/8 inch
The concrete mix design number Lot number
Sublot number HMA Design ID JMF3512-2021-89-L210556

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-06-02-40-1AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)Darrell ValasekCT D02 - North Region Materials Lab08/14/2021Darrell Valasek
No
Info