DIME - Test Summary

Summary for Test 2022-01-31-57-1

Test performed: CTM 213-December 2012

Project Identifiers	Project ID: 215486 DEA: 040A0204 EFIS: 0400000129
DIST-CO-RTE-PM	04-SON-1-15-15.7
Award Date	Not set
Closeout Date	Not set
Work Description	Construct roadway and bridge with structural concrete and CIDH piling
Location Description	District-County-Route-Post Mile: 04-Son-1-R15.0/R15.7
QA Service Level	1 (Verified on 04/08/2022)

Sample Taken Date	01/31/2022	Sample Unique Key	57
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	04/01/2022
Sample type	Quality Assurance	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	Jeff	Last name of sampler or witnessed by	Rhodes
Title of sampler	Plant QC	Telephone number of sampler
Laboratory sample identification	22-PCCF-0057	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Canyon Rock Quarry	Transportation Laboratory (TL) Number	C100504
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)	91-49-0004
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	Stock Pile
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: 2022-01-31-57

DIME Test ID: 2022-01-31-57-1

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: 2022-05-04

Input Type: Measured

Tester's full name: Bang Nguyen

Date of test: 05/03/2022

Is the sample satisfactory or not?: Yes

Does debris exist: No

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

Test was verified on 5/4/2022 ✔