Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2019-04-18-1

Project Information

Project IdentifiersProject ID: 211784
DEA: 11085784
EFIS: 1100000064
DIST-CO-RTE-PM11-SD-163-4.1/4.9
Award Date06/16/2017
Closeout Date08/10/2021
Work DescriptionINTERCHANGE MODIFICATION AND OVERCROSSING WIDENING.
Location DescriptionSAN DIEGO COUNTY IN SAN DIEGO FROM 0.3 MILE SOUTH TO 0.5 MILE NORTH OF FRIARS ROAD OVERCROSSING
QA Service Level1 (Verified on 09/05/2017)

Sample Information

Sample Taken Date04/18/2019 Sample Unique Key1
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 testing04/18/2019
Sample typeQuality Assurance A brief description of the sampleHilti HVU Adheasive Capsule
The quantity of what the sample constitutes5 From where was the sample collectedFabricator
First name of sampler or witnessed byLorenzo Last name of sampler or witnessed byGarcia
Title of samplerQA Telephone number of sampler702 917-2503
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameStructural and Steel Products Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL115-054-19 Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeMethacrylate Mfg. Lot Number(s)8211408
Batch numberHIT HY 200 R Mix number337111

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