DIME - Test Summary

Summary for Test 2018-12-06-17-1

Test performed: CTM 213-December 2012

Sample Taken Date	12/06/2018	Sample Unique Key	17
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 testing	01/29/2019
Sample type	Annual Source Testing	A brief description of the sample	Concrete Sand
The quantity of what the sample constitutes	1 bags	From where was the sample collected	Source
First name of sampler or witnessed by	plant	Last name of sampler or witnessed by	plant
Title of sampler	QC lab tech	Telephone number of sampler
Laboratory sample identification	19-0012	Linked DIME Sample ID
The fabricator/manufacturer/facility name	CEMEX CACHE CREEK	Transportation Laboratory (TL) Number	C859585
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier	Not set
Structure name	Not set	Bid Item	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-57-0008
The fabricator's/manufacturer's product name for the sample	CEMEX CACHE CREEK	The fabricator/manufacturer designation for the sample	Unknown
The plant number	Cemex Cache Creek	A detailed description of where the material sample was collected	plant
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size	fine
The concrete mix design number	Unknown	Lot number	0
Sublot number	0	Aggregate Mix Number	Not set

DIME Sample ID: 2018-12-06-17

DIME Test ID: 2018-12-06-17-1

Testing Lab: CT HQ - Sacramento Aggregate Testing Laboratory

Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand

Test Release Date: 2019-03-01

Input Type: Calculated

Tester's full name: Bang Nguyen

Date of test: 03/01/2019

Is the sample satisfactory or not?: Yes

Does debris exist: No

General comments (publicly viewable) (Max 1000 characters):

Test was verified on 3/1/2019 ✔