Sample Record

Owner Lab

  • CT QASI - Los Angeles Field Laboratory

DIME Sample ID 2017-07-25-7

Project Information

Project IdentifiersProject ID: 210569
DEA: 083555V4
EFIS: 0814000086
DIST-CO-RTE-PM08-SBD-15-42.5/46.0
Award Date11/05/2015
Closeout Date01/18/2022
Work DescriptionWIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location DescriptionSAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
QA Service Level1 (Verified on 10/15/2015)

Sample Information

Sample Taken Date07/25/2017 Sample Unique Key7
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 testingNot set
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes7.6 CY in Girder G16 and G25 From where was the sample collectedFabricator
First name of sampler or witnessed byDavid Last name of sampler or witnessed byWeeks
Title of samplerCT METS QA INSPECTOR Telephone number of sampler951-258-8382
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameOldcastle Precast, Perris Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierGirder G16 and G25
Structure nameBridge Number 54_0484

Material Information

Material TypeConcrete The concrete mix design numberUV-273-1
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected56419
Concrete batch plantOnsite The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedCasting Bed A2 Where the material sample would have been placed if not sampledGirder G16 and G25
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.