Test 2021-05-24-33-2 (CTM 227-December 2014) 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 Date5/24/2021 Sample Unique Key33
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 testing5/25/2021
Sample typeAggregate Prequalification Program A brief description of the sample1 X 4 Concrete Aggregate
The quantity of what the sample constitutesproduction stockpile. From where was the sample collectedSupplier
First name of sampler or witnessed byKevin Last name of sampler or witnessed byOwen
Title of samplerQuality Control Supervisor Laboratory sample identification
The fabricator/manufacturer/facility nameTeichert Materials Vernalis 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)91-39-0041
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 collectedPlant Stockpile
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size1 inch
The concrete mix design number Lot number
Sublot number HMA Design ID
Test Details
DIME Sample ID: 2021-05-24-33
DIME Test ID: 2021-05-24-33-2
Testing Lab: Teichert Materials - Sacramento
Test Method: CTM 227-December 2014: Method of Test for Evaluating Cleanness of Coarse Aggregate (Cleanness)
Test Release Date: 2021-06-10
Test Results

Describe the gradation of the aggregate or the test method:: Mix of sizes - max 1.5 in.
Input Type: Calculated
Tester's full name: Eric Gifford
Date of test: 05/26/2021
Cleanness value (11/2 in. maximum aggregate mix):79
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 06/10/2021