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Testing Report for 2014-03-20-11077038-1

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

Project Information

DEA: 04264144
EFIS: 0400002023
Project ID: 6842
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP,SOL-12-2.8/3.3,0.0/2.6
Work Description: WIDEN ROUTE 12 FROM A TWO-LANE TO A FOUR-LANE CONVENTIONAL HIGHWAY
Location Description: NAPA AND SOLANO COUNTIES FROM 0.5 MILE WEST OF NAPA COUNTY LINE TO RED TOP ROAD
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Elias Moussa
Structure Rep.: Robert Roman

Sample Information

DIME Sample ID: 2014-03-20-11077038
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Per Request
Type of Material: Aggregate
Sample Taken Date: 3/20/2014
Date that the sample was received by the laboratory/organization performing the testing: 3/3/2014
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Sand
From where was the sample collected: Source
Laboratory sample identification: 14FPCC-0095 C872690
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex

Material Information

Source Identification (SMARA or name of Pit): 91-39-0015
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: Cemex Kerlinger 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: 2014-03-20-11077038-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 3/20/2014
Verified Date: 3/21/2014
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:
Additional Comments When Verified :

Submitted Test Results

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