Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2017-12-06-10

Project Information

Project IdentifiersProject ID: 210735
DEA: 071193U4
EFIS: 0713000007
DIST-CO-RTE-PM07-LA-10-37.2/42.4
Award Date11/16/2015
Closeout Date07/11/2022
Work DescriptionCONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location DescriptionIN LA COUNTY FROM CITRUS STREET IN WEST COVINA TO ROUTE 57 IN POMONA
QA Service Level1 (Verified on 03/07/2016)

Sample Information

Sample Taken Date12/06/2017 Sample Unique Key10
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 testing12/11/2017
Sample typeQuality Control 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 bySAUL Last name of sampler or witnessed byFIERRO
Title of samplerUnknown Telephone number of samplerUnknown
Laboratory sample identification946-80 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameROBERTSONS Transportation Laboratory (TL) Number268080
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierRW 2181 FTG
Structure nameUnknown

Material Information

Material TypeConcrete The concrete mix design numberCM5645
The truck number from where the sample was collected629 The batch plant ticket number from where the sample was collected101116604
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedLOAD 5 Where the material sample would have been placed if not sampledUnknown
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