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Testing Report for 2014-12-12-3-1

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

Project Information

DEA: 04235844
EFIS: 0400000684
Project ID: 209135
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-16.3/17.06
Work Description: RECONSTRUCT OVERCROSSING, RETAINING WALLS, GROUND IMPROVEMENT,
Location Description: BURLINGAME
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Douglas Inori
Structure Rep.: Jordan Jarosz

Sample Information

DIME Sample ID: 2014-12-12-3
TL Number from the TL Form: C911215
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: 12/12/2014
Date that the sample was received by the laboratory/organization performing the testing: 1/23/2015
The quantity of what the sample constitutes: 1
A brief description of the sample: Concrete Blend Sand
From where was the sample collected: Source
Laboratory sample identification: 15-0050 6808-14C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Quail Hollow Felton

Material Information

Source Identification (SMARA or name of Pit): 91-44-0007
The fabricator's/manufacturer's product name for the sample: Quail Hollow
The fabricator/manufacturer designation for the sample: Blend Sand
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:
The concrete mix design number:
Lot number:
Sublot number:

Test Information

DIME Test ID: 2014-12-12-3-1
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Date Tested: 1/30/2015
Verified Date: 2/10/2015
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: comply
Additional Comments When Verified :

Submitted Test Results

Is the sample satisfactory or not?: Yes
Does debris exist: No