DIME - Test Summary

Summary for Test 2016-12-05-7-1

Test performed: CTM 213-December 2012

Project Identifiers	Project ID: 210162 DEA: 042J0704 EFIS: 0414000421 COOP: 042573
DIST-CO-RTE-PM	04-ALA-880-2.9/27.5
Award Date	03/15/2016
Closeout Date	10/21/2019
Work Description	REPLACEMENT OF MEDIAN BARRIER ON INTERSTATE 880
Location Description	REPLACEMENT OF MEDIAN BARRIER ON INTERSTATE 880
QA Service Level	1 (Verified on 10/27/2015)

Sample Taken Date	12/05/2016	Sample Unique Key	7
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	03/24/2017
Sample type	Annual Source Testing	A brief description of the sample	Fine PCC Aggregate
The quantity of what the sample constitutes	6 bags	From where was the sample collected	Source
First name of sampler or witnessed by	Curtis	Last name of sampler or witnessed by	Gilbert
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification	17FPCC-0160	Linked DIME Sample ID	Unknown
The fabricator/manufacturer/facility name	Vulcan Pleasanton	Transportation Laboratory (TL) Number	C714374
Inspector Lot Number from the Transportation Laboratory (TL) Form	Unknown	Structure unique identifier	Not set
Structure name	Not set

Material Type	Aggregate	Source Identification (SMARA, name of Pit or Job Site)	91-01-0010::CALMAT/PLEASANTON
The fabricator's/manufacturer's product name for the sample	Unknown	The fabricator/manufacturer designation for the sample	Unknown
The plant number	Unknown	A detailed description of where the material sample was collected	Stockpile @ Plant
Where the material sample would have been placed if not sampled	Unknown	Primary Aggregate Nominal Size	fine
The concrete mix design number	Unknown	Lot number	Not set
Sublot number	Not set	Aggregate Mix Number	Not set

DIME Sample ID: 2016-12-05-7

DIME Test ID: 2016-12-05-7-1

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: 2017-06-22

Input Type: Calculated

Tester's full name: Phillip Montes

Date of test: 06/22/2017

Is the sample satisfactory or not?: Yes

Does debris exist: No

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

Test was verified on 6/22/2017 ✔