*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Sample Record for 2018-10-03-27

Project Information

Project ID: 66666 DEA: APP EFIS: 0019000052 QA Service Level:
Work Description: Special project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Contractor Address:
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2018-10-03-27
TL Number from the TL Form:
Sample Submitted By Organization: CT SC Sub-unit 3668-105
Sample Organization Contact:
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 10/03/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Testing for APP
A brief description of the sample: Testing for APP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Source Identification (SMARA or name of Pit): Testing for APP
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 collected: Testing for APP
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1-1/2 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Results

Test Information 4 of 5

DIME Test ID: 2018-10-03-27-4
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Verified Date: 10/29/2018
Date Tested: 10/28/2018
Submitted By Organization: CT HQ - Sacramento Office of Structural Materials Field Laboratory
Organization Address: 5900 Folsom Blvd
Test General Comments:
Additional Comments When Verified: Testing app.admin email address again. -- Bob
Number of tests 1
Mass Determination Air
Method Performed no data
Mass of container filled with water 23 grams
Mass of oven-dry sample in air for Sample 1 34 grams
Mass of container filled with the sample and water for Sample 1 45 grams
Temperature of Water 78 °F
Specific Gravity for Sample 1 2.833