Sample Record

Owner Lab

  • CT HQ - Sacramento Materials Management Branch Field Office

DIME Sample ID 2017-11-01-15

Project Information

Project IdentifiersProject ID: 9999
DEA: 00000000
EFIS: 0000000000
COOP: 99999333399
MINOR: 333333
Permit Numbers: 555555 0400NRT0000
DIST-CO-RTE-PM03-SAC,OMG-888,99,80-0.6-0.6
Award DateNot set
Closeout DateNot set
Work DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
QA Service Level1 (Verified on 04/05/2013)

Sample Information

Sample Taken Date11/01/2017 Sample Unique Key15
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 testing11/01/2017
Sample typeVerification A brief description of the samplefor Verification
The quantity of what the sample constitutes1 From where was the sample collectedManufacturer
First name of sampler or witnessed byScott Last name of sampler or witnessed byESE
Title of samplerUnknown Telephone number of samplerUnknown
Laboratory sample identificationUnknown Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility namePacific Northwest Oil Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeAntistrip Additive Antistrip TypeLime Slurry Marinade
Antistrip Additive Mix NumberNot set

JMF Information

Verification IDJMF3513-2017-1 Date Created11/01/2017
JMF Submittal IDJMF3511-6-2017-1 JMF StatusSubmittal Authorized For Use
Producer Mix ID5202 Authorized Date03/15/2018

Submitted Tests

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

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Test File Attachments