Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2017-05-12-2

Project Information

Project IdentifiersProject ID: 208945
DEA: 07288604
EFIS: 0700021080
COOP: 074663
DIST-CO-RTE-PM07-LA-710-6.0-9.4
Award Date09/02/2011
Closeout DateNot set
Work DescriptionGerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location DescriptionPort of Long Beach (District 7)
QA Service Level1 (Verified on 06/03/2013)

Sample Information

Sample Taken Date05/12/2017 Sample Unique Key2
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing05/17/2017
Sample typeQuality Control A brief description of the sample6X12
The quantity of what the sample constitutes4 From where was the sample collectedJob Site
First name of sampler or witnessed byHLA Last name of sampler or witnessed byKYI
Title of samplerASSISTANT IQA ENGINEER Telephone number of sampler
Laboratory sample identification833-P3 Linked DIME Sample ID
The fabricator/manufacturer/facility nameON SITE Transportation Laboratory (TL) Number051217 RW-P LCC POUR3
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierOCEAN BLVD TO SR 47 IN LB
Structure nameRW P LCC POUR3 CLASS III

Material Information

Material TypeConcrete The concrete mix design numberMIXED ON SITE
The truck number from where the sample was collected The batch plant ticket number from where the sample was collectedNA
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedTREMIIE PIPE Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

File NameExtensionDate UploadedActions
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Test File Attachments