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Testing Report for 2021-02-05-23-4

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

Project Information

Project ID: 66666 DEA: APP EFIS: 0019000052 QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-02-05-23
TL Number from the TL Form:
Sample Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Sample Organization Contact: 5597930903
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 02/05/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/07/2021
The quantity of what the sample constitutes: about 140 lb
A brief description of the sample: 3/8" crushed rock APP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Deer Creek Rock and Asphalt

Material Information

Source Identification (SMARA or name of Pit): 91-54-0021
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile at plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2021-02-05-23-1
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Verified Date: 03/04/2021
Date Tested: 02/08/2021
Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Organization Address: 27671 Ave 120,
Organization City: Porterville
Organization State: CA
Organization Zipcode: 93257
Organization Email: ahasegawa@jaxonaggregates.com
Organization Phone: 5597930903
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

Percentage Loss of material retained on 2 x 1 ½ in. sieve no data
Percentage Loss of material retained on 1 ½ x 1 in. sieve no data
Percentage Loss of material retained on 1 x ¾ in. sieve no data
Percentage Loss of material retained on ¾ x ½ in. sieve no data
Percentage Loss of material retained on ½ x ⅜ in. sieve no data
Percentage Loss of material retained on ⅜ in. x #4 sieve no data
Weighted Average Percent Loss of Coarse Aggregate 1.1 %