*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Sample Record for 2018-12-03-1
Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000 QA Service Level: 1
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ Contractor Address: 1234 address
Resident Engineer: RE_first RE_last Structure Rep.: SR_Last, SR_First
DIME Sample ID: 2018-12-03-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 12/03/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: truck load
A brief description of the sample: oil
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Asphalt modifier supplier: