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Testing Report for 2021-01-05-24-1

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

Project Information

DEA: 041J5694
EFIS: 0419000313
Project ID: 214601
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0/21.8
Work Description: Barrier modifications, overhead signs, freeway lighting and electronic toll system components
Location Description: SANTA CLARA AND SAN MATEO COUNTIES FROM 0.3 MILE NORTH OF SAN ANTONIO ROAD TO 0.3 MILE SOUTH OF GRAND AVENUE INTERCHANGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Douglas Inori
Structure Rep.: Tyler Pinell

Sample Information

DIME Sample ID: 2021-01-05-24
TL Number from the TL Form: C924560
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 1/5/2021
Date that the sample was received by the laboratory/organization performing the testing: 4/1/2021
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: concrete sand
From where was the sample collected: Source
Laboratory sample identification: 21-PCCF-0056
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Orca Sand Hanson

Material Information

Source Identification (SMARA or name of Pit): 07-008-013
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
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2021-01-05-24-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 4/5/2021
Verified Date: 4/16/2021
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: bang.d.nguyen@dot.ca.gov
Organization Phone: (916) 227-7204
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

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