Test 2014-11-13-3-1 (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 Date11/13/2014 Sample Unique Key3
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 testing1/23/2015
Sample typeAnnual Source Testing A brief description of the sampleConcrete Blend Sand
The quantity of what the sample constitutes1 From where was the sample collectedSource
First name of sampler or witnessed byQC Last name of sampler or witnessed byQC
Title of samplerQC Laboratory sample identification15FPCC-0049
The fabricator/manufacturer/facility nameSyar Lake Herman Transportation Laboratory (TL) NumberC917849
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierNot set
Structure nameNot set
Material Information
Material TypeAggregate Source Identification (SMARA or name of Pit)Syar Lake Herman
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 Quarry
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: 2014-11-13-3
DIME Test ID: 2014-11-13-3-1
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: 2015-01-29
Test Results

Input Type: Calculated
Tester's full name: Ed Perez
Date of test: 01/28/2015
Is the sample satisfactory or not?: Yes
Does debris exist: No
General comments (publicly viewable) (Max 1000 characters):

Test was verified on 01/29/2015