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Testing Report for 2021-05-03-31-11

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

Project Information

Project ID: 214885 DEA: 080K1234 EFIS: 0815000242 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-64.6/75.3
Work Description: COLD PLANE ASPHALT CONCRETE PAVEMENT AND PLACE RHMA-G.
Location Description: SAN BERNARDINO COUNTY FROM 1.2 MILES SOUTH OF SIDEWINDER ROAD OVERCROSSING TO MOJAVE RIVER BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Taghreed Al-Khateeb Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-05-03-31
TL Number from the TL Form: 3939 Retest
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 05/03/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/29/2021
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: 1.5" PCC Aggregates
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons Lucern Quarry

Material Information

Source Identification (SMARA or name of Pit): 91-36-0116
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 @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1-1/2 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2021-05-03-31-6
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Submitted By Organization: CT - Southern Regional Laboratory
Organization Address: 13970 Victoria St,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 213-792-4794
Data has not been verified