Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2017-04-28-16

Project Information

Project IdentifiersProject ID: 211733
DEA: 024E4204
EFIS: 0200020283
DIST-CO-RTE-PM02-LAS,SIE-70,395-3.5/3.9,R0.0/R3.1,R0.0/R5.6
Award Date12/14/2016
Closeout Date12/12/2017
Work DescriptionRHMA-GG,COLD PLANEAC,POLYESTER CONC OVERLAY,PCCAPPROACH SLABS,STRIPING
Location DescriptionLASSEN AND SIERRA COUNTIES AT VARIOUS LOCATIONS
QA Service Level1 (Verified on 03/07/2017)

Sample Information

Sample Taken Date04/28/2017 Sample Unique Key16
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 testing04/28/2017
Sample typeAcceptance A brief description of the sample19mm virgin bin stockpiles
The quantity of what the sample constitutes13 bags 45lbs ea From where was the sample collectedManufacturer
First name of sampler or witnessed byTerry Last name of sampler or witnessed bySchmitt
Title of samplerTET Telephone number of samplerUnknown
Laboratory sample identificationD76905 17-03-S1 Linked DIME Sample IDD76905 17-03-S1
The fabricator/manufacturer/facility nameSNC Mustang Transportation Laboratory (TL) NumberT101 C847393
Inspector Lot Number from the Transportation Laboratory (TL) FormT101 C 847393 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeJob Mix Formula Partial Source Identification (SMARA or name of Pit)unknown
The fabricator's/manufacturer's product name for the sample19mm Virgin agg bins The fabricator/manufacturer designation for the sampleUnknown
The plant numberUnknown A detailed description of where the material sample was collectedPlant
Where the material sample would have been placed if not sampledUnknown Superpave or Non-superpave MixSuperpave
HMA Design ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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