Test 2020-12-04-17-1 (CTM 213-December 2012) Summary

Project Information
Project IdentifiersProject ID: 214114
DEA: 040A5394
EFIS: 0418000244
DIST-CO-RTE-PM04-SOL-80,12-11.4/12.8, 2.1/2.8
Work DescriptionWiden EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location DescriptionI-80/I-680/Route 12 Interchange
Sample Information
Sample Taken Date12/4/2020 Sample Unique Key17
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing12/22/2020
Sample typeQuality Assurance A brief description of the sampleFine
The quantity of what the sample constitutes1 bags From where was the sample collectedSource
First name of sampler or witnessed byplant Last name of sampler or witnessed byplant
Title of samplerQC lab tech Laboratory sample identification20-FPCC-0241
The fabricator/manufacturer/facility nameCemex Madison Cache Creek Transportation Laboratory (TL) NumberC043706
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name
Material Information
Material TypeAggregate Source Identification (SMARA or name of Pit)91-57-0008
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 collectedStockpile
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Sizefine
The concrete mix design number Lot number
Sublot number HMA Design ID
Test Details
DIME Sample ID: 2020-12-04-17
DIME Test ID: 2020-12-04-17-1
Testing Lab: CT HQ - Sacramento Aggregate Testing Laboratory
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Test Release Date: 2021-01-08
Test Results

Input Type: Measured
Tester's full name: Bang Nguyen
Date of test: 12/24/2020
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 01/08/2021