Test 2021-07-08-67-3 (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 Date7/8/2021 Sample Unique Key67
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 testing7/8/2021
Sample typeAggregate Prequalification Program A brief description of the sample#4 Washed PCC Sand
The quantity of what the sample constitutes4 bags of aggregate From where was the sample collectedSource
First name of sampler or witnessed byDaniel Last name of sampler or witnessed byMiltz
Title of samplerQC Technician Laboratory sample identification1390912612
The fabricator/manufacturer/facility nameGranite Handley Ranch Quarry 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)91-27-0028
The fabricator's/manufacturer's product name for the sampleNo. 4 Washed PCC Sand The fabricator/manufacturer designation for the sample
The plant number1766 A detailed description of where the material sample was collectedStockpile sample
Where the material sample would have been placed if not sampledUse in Salinas Hot Plant Primary Aggregate Nominal Sizefine
The concrete mix design number Lot number
Sublot number HMA Design ID
Test Details
DIME Sample ID: 2021-07-08-67
DIME Test ID: 2021-07-08-67-3
Testing Lab: Granite Construction - Coastal
Test Method: CTM 213-December 2012: Method of Test for Organic Impurities in Concrete Sand
Test Release Date: 2021-10-12
Test Results

Input Type: Calculated
Tester's full name: Randy Cortez
Date of test: 09/08/2021
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters): Ran by BSK Livermore.

Test was verified on 10/12/2021