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Testing Report for 2013-09-16-9101-3

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

Project Information

Project ID: 208944 DEA: 07187224 EFIS: 0700000189 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-126-R6.8/R9.2
Work Description: SR 126/Commerce Center Drive Interchange Project
Location Description: Northwest of the City of Santa Clarita in unincorporated Los Angeles County
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Daniel Widjaja Structure Rep.: Sarah Hartz

Sample Information

DIME Sample ID: 2013-09-16-9101
TL Number from the TL Form:
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: 09/16/2013
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2013
The quantity of what the sample constitutes: 3 Bags
A brief description of the sample: Washed Concrete Sand
From where was the sample collected: Source
Laboratory sample identification: 3241B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Palmdale

Material Information

Source Identification (SMARA or name of Pit): SMARA No. 91-19-0001
The fabricator's/manufacturer's product name for the sample: Washed Concrete Sand
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: 2013-09-16-9101-1
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Verified Date: 02/28/2014
Date Tested: 09/18/2013
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
General Comments for this Test:
Test Result Compliance: comply
Additional Comments When Verified :

Submitted Test Results

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