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Testing Report for 2020-04-10-8-2

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

Project Information

DEA: 071218W4
EFIS: 0700021119
Project ID: 7613
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Vladimir Gurfinkel
Structure Rep.: Gon Choi

Sample Information

DIME Sample ID: 2020-04-10-8
TL Number from the TL Form: 944442
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 4/10/2020
Date that the sample was received by the laboratory/organization performing the testing: 4/14/2020
The quantity of what the sample constitutes: 1 bag 50 cy
A brief description of the sample: 1" Aggregate for Acceptance
From where was the sample collected: Manufacturer
Laboratory sample identification: 9713
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Source Vulcan Sunvalley, Sampled from Security Paving Burbank

Material Information

Source Identification (SMARA or name of Pit): 00-00-0000
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: Security Paving OnSite
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: G3-16-PCC002
Lot number: Unknown
Sublot number: Unknown

Test Information

DIME Test ID: 2020-04-10-8-2
Test Method: CTM 227-December 2014: Method of Test for Evaluating Cleanness of Coarse Aggregate (Cleanness)
Date Tested: 4/21/2020
Verified Date: 5/11/2020
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

Cleanness value (single primary size): 84