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Testing Report for 2014-02-04-13005790-2

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

Project Information

DEA: 08368504
EFIS: 0800000628
Project ID: 208869
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-177.3/181.1
Work Description: CONSTRUCT COMMERCIAL VEHICLE ENFORCEMENT FACILITY (CVEF)
Location Description: SAN BERNARDINO COUNTY FROM 1.2 MILES NORTH OF NIPTON ROAD OVERCROSSING TO 0.5 MILE SOUTH OF YATES WELL ROAD OVERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: John Santos
Structure Rep.: Lawrence Monsalud

Sample Information

DIME Sample ID: 2014-02-04-13005790
TL Number from the TL Form:
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 2/4/2014
Date that the sample was received by the laboratory/organization performing the testing: 2/3/2014
The quantity of what the sample constitutes: 2 Bags
A brief description of the sample: Structural Backfill
From where was the sample collected: Source
Laboratory sample identification: 4057B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: I-15 PM 176 / 181 - F - Line Sta. 51 00 t0 52 00.

Material Information

The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: I-15 PM 176 / 181 - F - Line Sta. 51 00 to 52 00.
Where the material sample would have been placed if not sampled:

Test Information

DIME Test ID: 2014-02-04-13005790-2
Test Method: CTM 217-June 2011: Method of Test for Sand Equivalent
Date Tested: 2/4/2014
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:
Additional Comments When Verified :

Submitted Test Results

Number of tests: 1
Sand equivalent after temperature correction: 27