*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Sample Record for 2019-08-16-16


Project Information

DEA: No Project QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Contractor Address:
Resident Engineer: Unknown Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-08-16-16
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Field Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Verification
Type of Material: Antistrip Additive
Sample Taken Date: 08/16/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: One JMF Verification
A brief description of the sample: Aggregate, Loose Mix, Asphalt, LAS, RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Antistrip Type: LAS - liquid antistrip