Sample Record
Owner Lab
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2023-08-30-54
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 994633 DEA: 120T6604 EFIS: 1222000076 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-74-0.0/5.3 |
| Award Date | 03/22/2023 |
| Closeout Date | 07/01/2024 |
| Work Description | Cold plane AC pavement and place RHMA |
| Location Description | Orange County in and near San Juan Capistrano from Route 5/74 Separation to Gibby Road. |
| QA Service Level | 1 (Verified on 07/07/2023) |
Sample Information
| Sample Taken Date | 08/30/2023 | Sample Unique Key | 54 |
|---|---|---|---|
| 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 | 08/31/2023 |
| Sample type | Verification | A brief description of the sample | Scrap |
| The quantity of what the sample constitutes | 1 Bag Of Crumb Rubber Scrap | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Hector | Last name of sampler or witnessed by | Reyes |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 0449G-23 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | MM-Lake Elsinore | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Bid Item | Not set |
Material Information
| Material Type | Crumb Rubber Modifier | CRM Type | Scrap Tire |
|---|---|---|---|
| Crumb Rubber Modifier Mix Number | 53418180 |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2023-08-30-54-1 CTM 208-September 2011 (Verified)
DIME Test ID: 2023-08-30-54-2 CTM 385-July 2022 (Verified)