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Testing Report for 2019-12-31-4-2

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

Project Information

Project ID: 210735 DEA: 071193U4 EFIS: 0713000007 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-37.2/42.4
Work Description: CONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location Description: IN LA COUNTY FROM CITRUS STREET IN WEST COVINA TO ROUTE 57 IN POMONA
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Rodolfo Cao Structure Rep.: Win, David

Sample Information

DIME Sample ID: 2019-12-31-4
TL Number from the TL Form: C915129
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 12/31/2019
Date that the sample was received by the laboratory/organization performing the testing: 01/02/2020
The quantity of what the sample constitutes: 1 BAG
A brief description of the sample: 1" AGGREGATE PCC
From where was the sample collected: Source
Laboratory sample identification: 9078
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HOLIDAY ROCK upland

Material Information

Source Identification (SMARA or name of Pit): Unknown
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Unknown
Where the material sample would have been placed if not sampled: STG 5 VIA VERDE BRIDGE
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown

Test Information

DIME Test ID: 2019-12-31-4-1
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Verified Date: 03/19/2020
Date Tested: 01/03/2020
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:

Submitted Test Results

Cleanness value (11/2 in. maximum aggregate mix) 86