Sample Record
Owner Lab
- CT D01 - District 1 Materials Laboratory
DIME Sample ID 2023-05-16-19
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 994062 DEA: 010F5104 EFIS: 0116000015 |
|---|---|
| DIST-CO-RTE-PM | 01-MEN,HUM-101-R106.2/T106.8 |
| Award Date | 09/15/2022 |
| Closeout Date | 01/22/2024 |
| Work Description | SOUTH FORK EEL RIVER BRIDGE SEISMIC |
| Location Description | MENDOCINO AND HUMBOLDT COUNTIES NEAR COOKS VALLEY FROM 0.4 MILE SOUTH OF SOUTH FORK EEL RIVER BRIDGE TO 0.1 MILE NORTH OF ROUTE 271 |
| QA Service Level | 1 (Verified on 06/27/2022) |
Sample Information
| Sample Taken Date | 05/16/2023 | Sample Unique Key | 19 |
|---|---|---|---|
| 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 | 05/17/2023 |
| Sample type | Quality Assurance | A brief description of the sample | PCC cylinders |
| The quantity of what the sample constitutes | 2 - 6x12 cylinders | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Tyler | Last name of sampler or witnessed by | Reyes |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | C0154 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Mercer Fraser - Fortuna | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | none |
|---|---|---|---|
| The truck number from where the sample was collected | 3402 | The batch plant ticket number from where the sample was collected | none |
| Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
| A detailed description of where the material sample was collected | Back of Truck | Where the material sample would have been placed if not sampled | |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2023-05-16-19-1 CTM 521-June 2020 (Verified)