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Sample Record for 2013-09-16-7923

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

Project Information

Project ID: 208944 DEA: 07187224 EFIS: 0700000189 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-126-R6.8/R9.2
Work Description: SR 126/Commerce Center Drive Interchange Project
Location Description: Northwest of the City of Santa Clarita in unincorporated Los Angeles County
Contractor Name: C.A. Rasmussen, Inc.
Contractor Address: 28548 Livingston Avenue, Valencia, CA 91355-4171
Resident Engineer: Daniel Widjaja Structure Rep.: Hartz, Sarah

Sample Information

DIME Sample ID: 2013-09-16-7923
TL Number from the TL Form:
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 09/16/2013
Date that the sample was received by the laboratory/organization performing the testing: 10/04/2013
The quantity of what the sample constitutes: 8 Bags
A brief description of the sample: 1 x 4 PCC Aggregates
From where was the sample collected: Source
Laboratory sample identification: 3239B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Palmdale

Material Information

Source Identification (SMARA or name of Pit): SMARA No. 91-19-0001
The fabricator's/manufacturer's product name for the sample: 1 x 4 Pcc Aggregate
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Results

Test Information 5 of 5

DIME Test ID: 2013-09-16-7923-5
Test Method: CTM 227-June 2012: Method of Test for Evaluating Cleanness of Coarse Aggregate (Cleanness)
Verified Date: 02/28/2014
Date Tested: 09/18/2013
Submitted By Organization: CT - Southern Regional Laboratory
Organization Address: 13970 Victoria St,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 213-792-4794
General Comments for this Test:
Additional Comments When Verified:
Cleanness value (single primary size) 86

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.