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Testing Report for 2019-12-05-20-1

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

Project Information

DEA: 042K7504
EFIS: 0417000019
Project ID: 214059
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-152-7.6/M10.2
Work Description: ROADWAY REHAB, CURB RAMPS, SIGNALS, AND STRIPING UPGRADES.
Location Description: SANTA CLARA COUNTY IN GILROY FROM 0.3 MILE WEST OF SANTA TERESA BOULEVARD TO ROUTE 101
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Gene Malonzo
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-12-05-20
TL Number from the TL Form: C934603
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: 12/5/2019
Date that the sample was received by the laboratory/organization performing the testing: 2/14/2020
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: PCC Sand
From where was the sample collected: Source
Laboratory sample identification: 20-PCCF-0028
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan - Triangle Rock Los Banos

Material Information

Source Identification (SMARA or name of Pit): 91-24-0009::LOS BANOS
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
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: fine
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown

Test Information

DIME Test ID: 2019-12-05-20-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 4/3/2020
Verified Date: 4/7/2020
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