Test 2021-01-05-26-1 (CTM 213-December 2012) Summary

Project Information
Project IdentifiersProject ID: 214601
DEA: 041J5694
EFIS: 0419000313
DIST-CO-RTE-PM04-SM-101-0.0/21.8
Work DescriptionBarrier modifications, overhead signs, freeway lighting and electronic toll system components
Location DescriptionSANTA CLARA AND SAN MATEO COUNTIES FROM 0.3 MILE NORTH OF SAN ANTONIO ROAD TO 0.3 MILE SOUTH OF GRAND AVENUE INTERCHANGE
Sample Information
Sample Taken Date1/5/2021 Sample Unique Key26
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 testing4/1/2021
Sample typeAnnual Source Testing A brief description of the samplesand
The quantity of what the sample constitutes1 bag From where was the sample collectedSource
First name of sampler or witnessed byL Last name of sampler or witnessed byMagana
Title of samplerConsultant Laboratory sample identification21-PCCF-0058
The fabricator/manufacturer/facility nameOak 101 Sand Hanson Transportation Laboratory (TL) NumberC924562
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)07-008-013
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: 2021-01-05-26
DIME Test ID: 2021-01-05-26-1
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: 2021-04-16
Test Results

Input Type: Measured
Tester's full name: Ryan Kester
Date of test: 04/05/2021
Is the sample satisfactory or not?: Yes
Does debris exist: Yes
General comments (publicly viewable) (Max 1000 characters): 2 small pieces (about 2.5mmx1.2mm, and 2mmx2mm not floating, they are rested on top to the fine).

Test was verified on 04/16/2021