Test 2015-11-30-6-1 (CTM 213-December 2012) Summary

Project Information
Project IdentifiersProject ID: 7463
DEA: 042640U4
EFIS: 0412000195
DIST-CO-RTE-PM04-SON-101-0.9/3.6
Work DescriptionCONSTRUCT PETALUMA BLVD SOUTH INTERCHANGE, REPLACE PETALUMA RIVER BR
Location DescriptionSONOMA COUNTY IN AND NEAR PETALUMA FROM GUNN DRIVE TO ROUTE 101/116 SEPARATION AND OVERHEAD
Sample Information
Sample Taken Date11/30/2015 Sample Unique Key6
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 testing2/16/2016
Sample typeAnnual Source Testing A brief description of the sampleFine PCC Aggregate
The quantity of what the sample constitutes2 bags From where was the sample collectedSource
First name of sampler or witnessed byPlant Last name of sampler or witnessed byEmployee
Title of samplerQC Technician Laboratory sample identification16FPCC-0073
The fabricator/manufacturer/facility nameSyar Lake Herman Transportation Laboratory (TL) Numberc862737
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierNot set
Structure nameNot set
Material Information
Material TypeAggregate Source Identification (SMARA or name of Pit)91-48-0002
The fabricator's/manufacturer's product name for the sampleUnknown The fabricator/manufacturer designation for the sampleUnknown
The plant numberUnknown A detailed description of where the material sample was collectedStockpile
Where the material sample would have been placed if not sampledUnknown Primary Aggregate Nominal Size
The concrete mix design number Lot numberNot set
Sublot numberNot set HMA Design ID
Test Details
DIME Sample ID: 2015-11-30-6
DIME Test ID: 2015-11-30-6-1
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: 2016-03-14
Test Results

Input Type: Calculated
Tester's full name: Tom Stinnett
Date of test: 03/10/2016
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 03/14/2016