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Sample Record for 2013-10-14-13302422

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Project Information

Project ID: 208862 DEA: 080K7104 EFIS: 0800000366 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15,215-14.0/R16.4,16.0/17.8
Work Description: I-15/I-215 Interchange Improvements (Devore)
Location Description: On I-15 from 0.8 mile south of Glen Helen Parkway UC to 1.4 mile north of Kenwood Ave UC And On I-215 from 1.2 mile south of Devore Road OC to the I-15 junction
Contractor Name: Atkinson Construction,, LLC
Contractor Address: 1672 Devore Road, San Bernardino, CA 92407
Resident Engineer: Owen Spencer Structure Rep.: Gueltzow, Scott

Sample Information

DIME Sample ID: 2013-10-14-13302422
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: 10/14/2013
Date that the sample was received by the laboratory/organization performing the testing: 10/11/2013
The quantity of what the sample constitutes: 2 Bags
A brief description of the sample: Washed Concrete Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Upland

Material Information

Source Identification (SMARA or name of Pit): SMARA 91-36-0003
The fabricator's/manufacturer's product name for the sample: Washed Concrete Sand
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:
The concrete mix design number:
Lot number:
Sublot number:

Test Results

Test Information 4 of 5

DIME Test ID: 2013-10-14-13302422-4
Test Method: CTM 217-June 2011: Method of Test for Sand Equivalent
Verified Date: 02/20/2015
Date Tested: 11/15/2013
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:
Number of tests 1
Sand equivalent after temperature correction 82

Tests Assigned to this Sample

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