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Testing Report for 2016-06-07-15-1

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

Project Information

Project ID: 210946 DEA: 060T5904 EFIS: 0615000155 QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-137;190-18.2/27.4;26.5/56.6
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Shelley Maggard Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2016-06-07-15
TL Number from the TL Form: c983199
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 06/07/2016
Date that the sample was received by the laboratory/organization performing the testing: 06/14/2016
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Sand
From where was the sample collected: Source
Laboratory sample identification: 16FPCC-0246
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Deer Creek

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: Stockpile
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size:
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2016-06-07-15-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Verified Date: 06/28/2016
Date Tested: 06/22/2016
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email:
Organization Phone: (916) 227-7204
General Comments for this Test:
Additional Comments When Verified:

Submitted Test Results

Is the sample satisfactory or not? Yes
Does debris exist No