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Testing Report for 2013-06-21-7037731-1

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

Project Information

DEA: 060J0404
EFIS: 0600000156
Project ID: 7629
QA Service Level: 1
DIST-CO-RTE-PM: 06-KIN-41-R37.5/R38.1
Work Description: CONTSTRUCT LEFT TURN CHANNELIZATION AND INSTALL LIGHTING.
Location Description: KINGS COUNTY NEAR LEMOORE FROM 0.3 MILE SOUTH OF JACKSON AVENUE TO 0.3 MILE NORTH OF JACKSON AVENUE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Dallia Foster
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2013-06-21-7037731
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: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 6/21/2013
Date that the sample was received by the laboratory/organization performing the testing: 6/18/2013
The quantity of what the sample constitutes: 1Bag
A brief description of the sample: Sand
From where was the sample collected: Source
Laboratory sample identification: 13FPCC-0259 / C875895
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: J/Baker Auenal

Material Information

Source Identification (SMARA or name of Pit): None
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: 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: 2013-06-21-7037731-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 6/21/2013
Verified Date: 6/21/2013
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