Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2017-09-15-6

Project Information

Project IdentifiersProject ID: 211714
DEA: 080R1204
EFIS: 0812000026
DIST-CO-RTE-PM08-SBD-40-0.0/R25.0
Award Date12/21/2016
Closeout Date06/23/2021
Work DescriptionREGRADE MEDIAN CROSS SLOPE
Location DescriptionSAN BERNARDINO COUNTY IN AND NEAR BARSTOW FROM JUNCTION 15/40 TO 1.4 MILES EAST OF FORT CADY ROAD OVERCROSSING
QA Service Level1 (Verified on 09/21/2016)

Sample Information

Sample Taken Date09/15/2017 Sample Unique Key6
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 testing09/19/2017
Sample typeQuality Assurance A brief description of the sample6X12
The quantity of what the sample constitutes2 From where was the sample collectedJob Site
First name of sampler or witnessed byKENNEDY Last name of sampler or witnessed byE
Title of samplerNOT PROVIDED Telephone number of samplerUnknown
Laboratory sample identification957-517 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameROBERTSON BARSTOW Transportation Laboratory (TL) Number091517
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierDS
Structure nameUnknown

Material Information

Material TypeConcrete The concrete mix design number5264125A
The truck number from where the sample was collectedNOT PROVIDED The batch plant ticket number from where the sample was collectedNOT PROVIDED
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedLOAD 1 Where the material sample would have been placed if not sampledDS 126 STA 645 83
From Lot No.Unknown Bag Lot No.Unknown

Submitted Tests

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

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Test File Attachments