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Testing Report for 2021-02-26-7-4

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

Project Information

DEA: 050N73U4
EFIS: 0520000166
Project ID: 215129
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-7.3/9.6
Work Description: Segment 4C - Summerland: Construct HOV lanes and rehabilitation. Source inspection of sign structure trusses, lighting structures, steel soldier piles, epoxy coated rebar, headed rebar, welded hoops, column pins.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Tristan Gebhart
Structure Rep.: Bernardo Hernandez

Sample Information

DIME Sample ID: 2021-02-26-7
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultant
Sample Organization Contact: 1 (714) 974-6316
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 2/26/2021
Date that the sample was received by the laboratory/organization performing the testing: 2/26/2021
The quantity of what the sample constitutes: 100 cy
A brief description of the sample: 1 X 4 Concrete Aggregate
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Evans Bridge Abutment 1 and 4
The fabricator/manufacturer/facility name: Hanson Goleta

Material Information

Source Identification (SMARA or name of Pit): 91-42-0003
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: Belt cut of Coarse and Fine Aggregate at Source
Where the material sample would have been placed if not sampled: Evans Bridge Abutment 1 and 4
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: 63511N0P
Lot number:
Sublot number:

Test Information

DIME Test ID: 2021-02-26-7-4
Test Method: CTM 227-December 2014: Method of Test for Evaluating Cleanness of Coarse Aggregate (Cleanness)
Date Tested: 3/1/2021
Verified Date: 3/8/2021
Submitted By Organization: Sequoia Consultant
Organization Address: 361 W Grove Ave,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email:
Organization Phone: 1 (714) 974-6316
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

Cleanness value (11/2 in. maximum aggregate mix): 91