Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2022-04-02-14

Project Information

Project IdentifiersProject ID: 214671
DEA: 07303904
EFIS: 0714000044
DIST-CO-RTE-PM07-LA-10-31.2/37.2
Award Date11/25/2020
Closeout Date10/11/2023
Work DescriptionLANE REPLACEMENT
Location DescriptionLOS ANGELES COUNTY IN BALDWIN PARK AND WEST COVINA FROM 0.1 MILE EAST OF THE 10/605 SEPARATION TO 0.3 MILE WEST OF CITRUS STREET OVERCROSSING
QA Service Level1 (Verified on 01/21/2021)

Sample Information

Sample Taken Date04/02/2022 Sample Unique Key14
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 testing04/02/2022
Sample typeDepartment Acceptance A brief description of the sample6"x12" LCBRS cylinder
The quantity of what the sample constitutes500 cubic yards From where was the sample collectedSource
First name of sampler or witnessed byGeorge Last name of sampler or witnessed byZacarias
Title of samplerG3 Quality Technician Telephone number of sampler
Laboratory sample identification22-0628 Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving batch plant Transportation Laboratory (TL) Number22-0628
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design numberG3-22LRS-271R
The truck number from where the sample was collected1987 The batch plant ticket number from where the sample was collected235421
Concrete batch plantSecurity Paving Durbin The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedDischarge from concrete truck into wheelbarrow. Where the material sample would have been placed if not sampledNA
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments