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Testing Report for 2019-12-01-2-2

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

Project Information

DEA: APP
EFIS: 0019000052
Project ID: 66666
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-12-01-2
TL Number from the TL Form:
Sample Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Sample Organization Contact: 5597930903
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 12/1/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 buckets
A brief description of the sample: Concrete agg 3/8" Crushed
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Deer Creek Rock and Aspahlt

Material Information

Source Identification (SMARA or name of Pit): 91-54-0021::DEER CREEK QUARRY
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 sample by loader bucket
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2019-12-01-2-2
Test Method: CTM 227-December 2014: Method of Test for Evaluating Cleanness of Coarse Aggregate (Cleanness)
Date Tested: 12/6/2019
Verified Date: 3/18/2020
Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Organization Address: 27671 Ave 120,
Organization City: Porterville
Organization State: CA
Organization Zipcode: 93257
Organization Email: ahasegawa@jaxonaggregates.com
Organization Phone: 5597930903
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified :

Submitted Test Results

Cleanness value (single primary size): 91