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Testing Report for 2016-06-13-10-2

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

Project Information

DEA: 081G1004
EFIS: 0815000125
Project ID: 211091
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-36.5/42.6
Work Description: REPLACE ASPHALT CONCRETE SURFACING AND SLURRY SEAL
Location Description: REPLACE ASPHALT CONCRETE SURFACING AND SLURRY SEAL
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Chad Yang
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2016-06-13-10
TL Number from the TL Form: C 985243
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 6/13/2016
Date that the sample was received by the laboratory/organization performing the testing: 6/17/2016
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Aggregate Type III for Slurry Seal
From where was the sample collected: Job Site
Laboratory sample identification: 6255B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Chandler Corona

Material Information

Source Identification (SMARA or name of Pit): Unknown
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Job Site
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2016-06-13-10-2
Test Method: CTM 217-June 2011: Method of Test for Sand Equivalent
Date Tested: 6/21/2016
Verified Date: 10/15/2019
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: complies
Additional Comments When Verified :

Submitted Test Results

Number of tests: 1
Sand equivalent after temperature correction: 72