Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2017-10-06-6

Project Information

Project IdentifiersProject ID: 211954
DEA: 022H4804
EFIS: 0216000106
DIST-CO-RTE-PM02-TRI-36-R3.5/R9.2
Award Date02/27/2017
Closeout Date04/02/2021
Work DescriptionCOLD IN-PLACE RECYCLE WITH HOT MIX ASPHALT OVERLAY AND GUARDRAIL
Location DescriptionTRINITY COUNTY NEAR MAD RIVER FROM 0.1 MILE EAST OF MAD RIVER ROAD TO 0.1 MILE WEST OF SOUTH FORK MOUNTAIN ROAD
QA Service Level1 (Verified on 07/27/2017)

Sample Information

Sample Taken Date10/06/2017 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 testing10/06/2017
Sample typeAcceptance A brief description of the sample1/2 Cold Feed and Rap
The quantity of what the sample constitutes1 bag each bin 40 lbs each From where was the sample collectedManufacturer
First name of sampler or witnessed byJoe Last name of sampler or witnessed bySturges
Title of samplerPEI Tester Telephone number of samplerUnknown
Laboratory sample identificationD77199 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameTullis Northstate Asphalt Transportation Laboratory (TL) NumberT101 C852081
Inspector Lot Number from the Transportation Laboratory (TL) FormT101 C852081 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)Unknown
The fabricator's/manufacturer's product name for the sampleCold feed and rap 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 Primary Aggregate Nominal Size1/2 inch
The concrete mix design numberUnknown Lot numberNot set
Sublot numberNot set HMA Design ID

Submitted Tests

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