Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2018-06-15-13

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 Date06/15/2018 Sample Unique Key13
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 testing06/19/2018
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes2 From where was the sample collectedJob Site
First name of sampler or witnessed byWEIN KUNA Last name of sampler or witnessed byHSIA
Title of samplerASR Telephone number of samplerUnknown
Laboratory sample identification946-485B Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameHOLIDAY ROCK Transportation Laboratory (TL) Number946-485B
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierRW 2116 CIP
Structure nameRW 2116 CIP

Material Information

Material TypeConcrete The concrete mix design numberNA
The truck number from where the sample was collected647 The batch plant ticket number from where the sample was collected101126272
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleATKINSON
A detailed description of where the material sample was collectedLOAD 6 Where the material sample would have been placed if not sampledRW 2116 CIP
From Lot No.Unknown Bag Lot No.Unknown

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