Sample Record

Owner Lab

  • CT D04 - Petaluma Field Laboratory

DIME Sample ID 2023-02-10-47

Project Information

Project IdentifiersProject ID: 215486
DEA: 040A0204
EFIS: 0400000129
DIST-CO-RTE-PM04-SON-1-15-15.7
Award DateNot set
Closeout DateNot set
Work DescriptionConstruct roadway and bridge with structural concrete and CIDH piling
Location DescriptionDistrict-County-Route-Post Mile: 04-Son-1-R15.0/R15.7
QA Service Level1 (Verified on 04/08/2022)

Sample Information

Sample Taken Date02/10/2023 Sample Unique Key47
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 testing02/10/2023
Sample typeQuality Assurance A brief description of the sampleHMA Aggregates
The quantity of what the sample constitutes4 Bags From where was the sample collectedSource
First name of sampler or witnessed byAnthony Last name of sampler or witnessed byValdez
Title of samplerConsultant Telephone number of sampler916-837-3760
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameBoDean Santa Rosa Transportation Laboratory (TL) Number861615
Inspector Lot Number from the Transportation Laboratory (TL) Form1 Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA, name of Pit or Job Site)91-49-0032
The fabricator's/manufacturer's product name for the sample700-SPW-16 The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedPulled from Bin 2
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size3/8 inch
The concrete mix design number Lot number1
Sublot number1 Aggregate Mix Number

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