Sample Record

Owner Lab

  • CT SC Sub-unit 3668-105

DIME Sample ID 2018-10-03-27

Project Information

Project IdentifiersProject ID: 66666
DEA: APP
EFIS: 0019000052
DIST-CO-RTE-PM59---
Award DateNot set
Closeout DateNot set
Work DescriptionSpecial project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location DescriptionNot set
QA Service LevelNOT VERIFIED

Sample Information

Sample Taken Date10/03/2018 Sample Unique Key27
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeAggregate Prequalification Program A brief description of the sampleTesting for APP
The quantity of what the sample constitutesTesting for APP From where was the sample collectedSource
First name of sampler or witnessed byTesting for APP Last name of sampler or witnessed byTesting for APP
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameTesting for APP Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)Testing for APP
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedTesting for APP
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size1-1/2 inch
The concrete mix design number Lot numberNot set
Sublot numberNot set HMA Design ID
HMA PayNo

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