Test 2021-04-16-32-5 (CTM 213-December 2012) Summary

Project Information
Project IdentifiersProject ID: 66666
DEA: APP
EFIS: 0019000052
DIST-CO-RTE-PM59---
Work DescriptionSpecial project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location DescriptionNot set
Sample Information
Sample Taken Date4/16/2021 Sample Unique Key32
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 testing4/16/2021
Sample typeAggregate Prequalification Program A brief description of the sampleFine PCC Aggregate
The quantity of what the sample constitutes4 Bags From where was the sample collectedSource
First name of sampler or witnessed byMarc Last name of sampler or witnessed bySegura
Title of samplerQC Supervisor Laboratory sample identification
The fabricator/manufacturer/facility nameCemex Moorpark Transportation Laboratory (TL) Number
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)91-56-0014
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number4425 A detailed description of where the material sample was collectedProduction stockpile
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: 2021-04-16-32
DIME Test ID: 2021-04-16-32-5
Testing Lab: Cemex - Central & Southern California
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Test Release Date: 2021-05-18
Test Results

Input Type: Calculated
Tester's full name: Marc Segura
Date of test: 04/16/2021
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 05/18/2021