Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2025-07-22-33

Project Information

Project IdentifiersProject ID: 994962
DEA: 07357304
EFIS: 0719000062
DIST-CO-RTE-PM07-LA-5-6.6/13.1
Award Date04/27/2023
Closeout DateNot set
Work DescriptionREPLACE CONCRETE SLABS AND MEDIAN BARRIER,
Location DescriptionLOS ANGELES COUNTY IN SANTA FE SPRINGS, DOWNEY AND CITY OF COMMERCE FROM 0.2 MILE SOUTH OF ROUTE 5/605 SEPARATION TO 0.1 MILE NORT
QA Service Level1 (Verified on 07/13/2023)

Sample Information

Sample Taken Date07/22/2025 Sample Unique Key33
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 testing07/24/2025
Sample typeVerification A brief description of the samplePSU RHMA-G-SP
The quantity of what the sample constitutes1 Bag CRM RBR From where was the sample collectedManufacturer
First name of sampler or witnessed byVictor Last name of sampler or witnessed byPham
Title of sampler Telephone number of sampler
Laboratory sample identification0458G-25 Linked DIME Sample ID
The fabricator/manufacturer/facility nameAAA-Corona/ Irwindale/ SJR/ Rohm & HAAS (Morelife) Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name Bid ItemNot set

Material Information

Material TypeCrumb Rubber Modifier CRM TypeScrap Tire
Crumb Rubber Modifier Mix Number106836

Submitted Tests

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