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Sample Record for 2019-01-24-15


Project Information

Project ID: 66667 DEA: JMFPP EFIS: 0019000043 QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Contractor Address:
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-01-24-15
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 01/24/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1
A brief description of the sample: 3/4 Inch HMA-A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Source Identification (SMARA or name of Pit): 91-54-0021::DEER CREEK QUARRY
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: Stockpile @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Results

Test Information 8 of 11

DIME Test ID: 2019-01-24-15-10
Test Method: AASHTO T104-99r16: Standard Method of Test for Soundness of Aggregate by Use of Sodium Sulfate or Magnesium Sulfate (Soundness)
Verified Date: 04/10/2019
Date Tested: 01/24/2019
Submitted By Organization: CT HQ - Hot Mix Asphalt Laboratory
Organization Address: 5900 Folsom Blvd
Test General Comments: Sodium sulfate soundness T-104
Additional Comments When Verified:
Size of aggregate being tested Coarse and Fine Aggregate
What type of solution was used? Sodium sulfate
What was the condition of the solution? Freshly prepared
Number of immersion cycles performed 5
Coarse weighted average loss 1 %
Fine weighted average loss 2 %