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Testing Report for 2016-11-29-11-1

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

Project Information

DEA: 041K8004
EFIS: 0416000316
Project ID: 211321
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-121-16.7/16.9
Work Description: Install temporary one-way traffic control signals, construct soldier pile retaining wall, reconstruct roadway, place RSP & perform miscellaneous related work
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Danilo Patenia
Structure Rep.: Chris Moulton

Sample Information

DIME Sample ID: 2016-11-29-11
TL Number from the TL Form: C872323
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 11/29/2016
Date that the sample was received by the laboratory/organization performing the testing: 3/14/2017
The quantity of what the sample constitutes: bags
A brief description of the sample: Fine PCC Aggregate
From where was the sample collected: Source
Laboratory sample identification: 17CPCC-0123
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Kerlinger

Material Information

Source Identification (SMARA or name of Pit): 91-39-0015::KERLINGER - RHODES
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: Stockpile @ Plant
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: fine
The concrete mix design number: Unknown
Lot number:
Sublot number:

Test Information

DIME Test ID: 2016-11-29-11-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 5/30/2017
Verified Date: 5/30/2017
Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: bang.d.nguyen@dot.ca.gov
Organization Phone: (916) 227-7204
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

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