DIME - Test Summary

Summary for Test 2017-12-19-26-1

Test performed: CTM 213-December 2012

Sample Taken Date	12/19/2017	Sample Unique Key	26
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	04/03/2018
Sample type	Annual Source Testing	A brief description of the sample	Sand
The quantity of what the sample constitutes	1 bag	From where was the sample collected	Source
First name of sampler or witnessed by	Joy	Last name of sampler or witnessed by	Sharma
Title of sampler	Unknown	Telephone number of sampler	Unknown
Laboratory sample identification	18-0064	Linked DIME Sample ID	Unknown
The fabricator/manufacturer/facility name	Cemex Madison	Transportation Laboratory (TL) Number	C859576
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)	91-57-0008::SOLANO CONCRETE OFF-CHANNEL
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	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
HMA Pay	No

DIME Sample ID: 2017-12-19-26

DIME Test ID: 2017-12-19-26-1

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: 2018-04-25

Input Type: Calculated

Tester's full name: Phillip Montes

Date of test: 04/25/2018

Is the sample satisfactory or not?: Yes

Does debris exist: No

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

Test was verified on 4/25/2018 ✔