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Testing Report for 2021-08-20-42-2

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.
Location Description: SUMMERLAND FROM 0.2 MILES NORTH OF PARDARO LANE OVERCROSSING TO SAN YSIDRO CREEK BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Tristan Gebhart
Structure Rep.: Bernardo Hernandez

Sample Information

DIME Sample ID: 2021-08-20-42
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: 8/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 8/24/2021
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: 1" & sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
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: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2021-08-20-42-2
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Date Tested: 8/24/2021
Verified Date: 9/13/2021
Submitted By Organization: Sequoia Consultant
Organization Address: 361 W Grove Ave,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

No reportable test results have been submitted for this test.