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Testing Report for 2020-11-25-13-1

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

Project Information

DEA: 043E6024
EFIS: 0414000084
Project ID: 215218
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-101-6.7/8.1
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G AND HMA (TYPE A).
Location Description: THE CITY AND COUNTY OF SAN FRANCISCO FROM VAN NESS AVENUE TO LYON STREET
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-11-25-13
TL Number from the TL Form: C934622
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: 11/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 5/13/2021
The quantity of what the sample constitutes: 1 bags
A brief description of the sample: Fine PCC Aggregate
From where was the sample collected: Source
Laboratory sample identification: 21-PCCC-0093
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Los Banos TRP

Material Information

Source Identification (SMARA or name of Pit): 91-24-0009
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: not provided
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: 2020-11-25-13-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 5/18/2021
Verified Date: 6/1/2021
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