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Testing Report for 2021-04-16-27-6

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

Project Information

EFIS: 0019000052
Project ID: 66666
QA Service Level:
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: 2021-04-16-27
TL Number from the TL Form:
Sample Submitted By Organization: Cemex - Central & Southern California
Sample Organization Contact: (510)378-2044
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 4/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 4/16/2021
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: PCC Fine Aggregate
From where was the sample collected: Source
Laboratory sample identification: 2021-04-22-29
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Redlands

Material Information

Source Identification (SMARA or name of Pit): 91-36-0068
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 4420
A detailed description of where the material sample was collected: Production 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: 2021-04-16-27-6
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 4/16/2021
Verified Date: 5/17/2021
Submitted By Organization: Cemex - Central & Southern California
Organization Address: 3990 Concours,
Organization City: Ontario
Organization State: CA
Organization Zipcode: 91764
Organization Email:
Organization Phone: (510)378-2044
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

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