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Testing Report for 2021-07-30-30-1

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: 2021-07-30-30
TL Number from the TL Form:
Sample Submitted By Organization: Holliday Rock Co., Inc.
Sample Organization Contact: 19099821553
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 7/30/2021
Date that the sample was received by the laboratory/organization performing the testing: 8/3/2021
The quantity of what the sample constitutes: 12 Bags
A brief description of the sample: WCS
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Rock Co, Inc

Material Information

Source Identification (SMARA or name of Pit): 91-19-0001
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: 2021-07-30-30-1
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Date Tested: 8/25/2021
Verified Date: 10/6/2021
Submitted By Organization: Holliday Rock Co., Inc.
Organization Address: 1401 N. Benson Ave.,
Organization City: Upland
Organization State: CA
Organization Zipcode: 91786
Organization Email:
Organization Phone: 19099821553
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.