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Testing Report for 2019-09-17-24-8

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

Project Information

DEA: 073W8604
EFIS: 0717000117
Project ID: 214000
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-35.3/46.9
Work Description: APPLY SLURRY SEAL TO ROADWAY.
Location Description: LOS ANGELES COUNTY IN SANTA MONICA AND MALIBU FROM 0.3 MILE SOUTH OF PALISADE PEDESTRIAN OVERCROSSING TO MALIBU LAGOON BRIDGE
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Frank Shin
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-09-17-24
TL Number from the TL Form: C914200
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Per Request
Type of Material: Aggregate
Sample Taken Date: 9/17/2019
Date that the sample was received by the laboratory/organization performing the testing: 9/19/2019
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Type 3 Slurry Seal/Micro-surfacing
From where was the sample collected: Source
Laboratory sample identification: 8719
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: United Rock-Irwindale

Material Information

Source Identification (SMARA or name of Pit): Unknown
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 at staging yard
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown

Test Information

DIME Test ID: 2019-09-17-24-8
Test Method: CTM 205-December 2010: Method of Test for Determining Percentage of Crushed Particles
Date Tested: 9/26/2019
Verified Date: 10/9/2019
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: complies
Additional Comments When Verified :

Submitted Test Results

Percent Coarse Crushed: 100 %
Percent Fine Crushed: 100 %