Test 2021-05-25-34-3 (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 Date5/25/2021 Sample Unique Key34
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 testing6/21/2021
Sample typeAggregate Prequalification Program A brief description of the sampleConcrete Sand
The quantity of what the sample constitutesproduction stockpile. From where was the sample collectedSupplier
First name of sampler or witnessed byMike Last name of sampler or witnessed byKocunik
Title of samplerSupevisor Laboratory sample identification21-APPF-0120
The fabricator/manufacturer/facility nameTeichert Materials Perkins 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)91-34-0053
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 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: 2021-05-25-34
DIME Test ID: 2021-05-25-34-3
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: 2021-07-21
Test Results

Input Type: Measured
Tester's full name: Jay Horton
Date of test: 07/01/2021
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 07/21/2021