DIME - Test Summary

Summary for Test 2021-11-09-52-1

Test performed: CTM 213-December 2012

Project Identifiers	Project ID: 214114 DEA: 040A5394 EFIS: 0418000244
DIST-CO-RTE-PM	04-SOL-80,12-11.4/12.8, 2.1/2.8
Award Date	Not set
Closeout Date	02/24/2023
Work Description	Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc.
Location Description	I-80/I-680/Route 12 Interchange
QA Service Level	1 (Verified on 04/23/2019)

Sample Taken Date	11/09/2021	Sample Unique Key	52
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 testing	12/21/2021
Sample type	Annual Source Testing	A brief description of the sample	Fine Aggregate
The quantity of what the sample constitutes	1 bag	From where was the sample collected	Source
First name of sampler or witnessed by	Plant	Last name of sampler or witnessed by	Plant
Title of sampler	QC Lab	Telephone number of sampler
Laboratory sample identification	21-PCCF-0220	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Cemex Cache Creek Plant	Transportation Laboratory (TL) Number	C044054
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-57-0008
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 collected	Source
Where the material sample would have been placed if not sampled		Primary Aggregate Nominal Size	fine
The concrete mix design number		Lot number
Sublot number		Aggregate Mix Number	Not set

DIME Sample ID: 2021-11-09-52

DIME Test ID: 2021-11-09-52-1

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: 2022-01-13

Input Type: Calculated

Tester's full name: Bang Nguyen

Date of test: 01/13/2022

Is the sample satisfactory or not?: Yes

Does debris exist: No

General comments (publicly viewable) (Max 1000 characters):

Test was verified on 1/13/2022 ✔