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Testing Report for 2013-10-14-13302422-3

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

Project Information

DEA: 080K7104
EFIS: 0800000366
Project ID: 208862
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15,215-14.0/R16.4,16.0/17.8
Work Description: I-15/I-215 Interchange Improvements (Devore)
Location Description: On I-15 from 0.8 mile south of Glen Helen Parkway UC to 1.4 mile north of Kenwood Ave UC And On I-215 from 1.2 mile south of Devore Road OC to the I-15 junction
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Owen Spencer
Structure Rep.: Scott Gueltzow

Sample Information

DIME Sample ID: 2013-10-14-13302422
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: 10/14/2013
Date that the sample was received by the laboratory/organization performing the testing: 10/11/2013
The quantity of what the sample constitutes: 2 Bags
A brief description of the sample: Washed Concrete Sand
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holliday Upland

Material Information

Source Identification (SMARA or name of Pit): SMARA 91-36-0003
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:
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2013-10-14-13302422-3
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 10/14/2013
Verified Date: 2/20/2015
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