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Sample Record for 2020-01-01-9

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

Project Information

Project ID: 213943 DEA: 051G5704 EFIS: 0515000049 QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-58-0.7/1.9
Work Description: COLD PLANE AC, PLACE RHMA-G AND RECONSTRUCT CURB RAMPS.
Location Description: SAN LUIS OBISPO COUNTY AT SANTA MARGARITA FROM 0.7 MILE EAST OF ROUTE 101/58 SEPARATION TO J STREET
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Hassan Iman Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-01-01-9
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Quality Control
Type of Material: Crumb Rubber Modifier
Sample Taken Date: 01/01/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 0
A brief description of the sample: CRM
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CRM

Material Information

CRM Type: High Natural
Crumb Rubber Modifier Mix Number:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2020-01-01-9-1
Test Method: CTM 385-November 2016: Method of Test for Sampling and Testing Crumb Rubber Modifier (CRM)
Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Organization Address: 50 Higuera Street,
Organization City: San Luis Obispo
Organization State: CA
Organization Zipcode: 93401
Organization Email: doug.lambert@dot.ca.gov
Organization Phone: (559) 230-3109
This test has been superseded on 01/17/2020.
Reason: corrected

Test 2 of 3

DIME Test ID: 2020-01-01-9-2
Test Method: ASTM D297-15: Standard Test Methods for Rubber Products - Chemical Analysis (Chemical Analysis)
Verified Date: 01/17/2020
Date Tested: 01/01/2020
Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Organization Address: 50 Higuera Street,
Organization City: San Luis Obispo
Organization State: CA
Organization Zipcode: 93401
Organization Email: glenn.johnson@dot.ca.gov
Organization Phone: (805) 549-3158
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
CRM Type High Natural
Natural rubber content in high natural CRM 41.9 %

Test 3 of 3

DIME Test ID: 2020-01-01-9-3
Test Method: CTM 385-November 2016: Method of Test for Sampling and Testing Crumb Rubber Modifier (CRM)
Verified Date: 01/17/2020
Date Tested: 01/01/2020
Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Organization Address: 50 Higuera Street,
Organization City: San Luis Obispo
Organization State: CA
Organization Zipcode: 93401
Organization Email: glenn.johnson@dot.ca.gov
Organization Phone: (805) 549-3158
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
CRM Gradation Type High Natural
High Natural CRM gradation (% passing No. 10 sieve) 100 %
Wire in CRM no data
Fabric in CRM no data