DIME - Test Summary

Summary for Test 2023-01-26-100-1

Test performed: CTM 213-December 2012

Project Identifiers	Project ID: 993776 DEA: 040J3004 EFIS: 0413000433
DIST-CO-RTE-PM	04-SON-1-26.7/27.1
Award Date	07/08/2022
Closeout Date	Not set
Work Description	CONSTRUCTING RETAINING WALL AND CONFINEMENT SYSTEM TO RESTORE SLIPOUT.
Location Description	SONOMA COUNTY NEAR JENNER FROM 0.3 MILE TO 0.7 MILE NORTH OF MEYERS GRADE ROAD
QA Service Level	1 (Verified on 05/11/2022)

Sample Taken Date	01/26/2023	Sample Unique Key	100
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	02/24/2023
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	Plant QC	Telephone number of sampler
Laboratory sample identification	23-ASF-0034	Linked DIME Sample ID
The fabricator/manufacturer/facility name	Syar Healdsburg	Transportation Laboratory (TL) Number	C044742
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)	91-49-0030
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	Healdsburg CA
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

DIME Sample ID: 2023-01-26-100

DIME Test ID: 2023-01-26-100-1

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: 2023-05-02

Input Type: Measured

Tester's full name: Bang Nguyen

Date of test: 04/20/2023

Is the sample satisfactory or not?: Yes

Does debris exist: No

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

Test was verified on 5/2/2023 ✔