Sample Record

Owner Lab

  • CT D01 - District 1 Materials Laboratory

DIME Sample ID 2019-10-29-2

Project Information

Project IdentifiersProject ID: 214136
DEA: 010F3604
EFIS: 0115000115
DIST-CO-RTE-PM01-HUM-101-R39.2/R48.3
Award Date07/31/2019
Closeout Date01/04/2021
Work DescriptionCOLD PLANE AC PAVEMENT, RHMA OVERLAY, AND GUARDRAIL INSTALLATION.
Location DescriptionHUMBOLDT COUNTY NEAR REDCREST, PEPPERWOOD, AND STAFFORD FROM ENGLWOOD PARK UNDERCROSSING TO EEL RIVER BRIDGE AND OVERHEAD
QA Service Level1 (Verified on 06/24/2019)

Sample Information

Sample Taken Date10/29/2019 Sample Unique Key2
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 testing10/22/2019
Sample typeQuality Assurance A brief description of the sampleagg
The quantity of what the sample constitutesJMF From where was the sample collectedManufacturer
First name of sampler or witnessed byleif Last name of sampler or witnessed byayres
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility namemf B Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA, name of Pit or Job Site)91-12-0002
The fabricator's/manufacturer's product name for the sampleUnknown The fabricator/manufacturer designation for the sampleUnknown
The plant numberUnknown A detailed description of where the material sample was collectedstockpile
Where the material sample would have been placed if not sampledUnknown Primary Aggregate Nominal Sizefine
The concrete mix design numberUnknown Lot numberUnknown
Sublot numberUnknown Aggregate Mix NumberNot set

JMF Information

HMA Design IDJMF3512-2019-135-test Date Created10/29/2019
SubmittalN/A

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