Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2020-09-17-9
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-405,73,405,605-9.3/24.3 |
| Award Date | 11/07/2016 |
| Closeout Date | Not set |
| Work Description | (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP. |
| Location Description | Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2 |
| QA Service Level | 1 (Verified on 09/10/2015) |
Sample Information
| Sample Taken Date | 09/17/2020 | Sample Unique Key | 9 |
|---|---|---|---|
| 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 testing | 09/21/2020 |
| Sample type | Verification | A brief description of the sample | Concrete Cylinders for 28-Day testing |
| The quantity of what the sample constitutes | 2 6x12 concrete cylinders | From where was the sample collected | Source |
| First name of sampler or witnessed by | Ramsey | Last name of sampler or witnessed by | Doumani |
| Title of sampler | QA Inspector | Telephone number of sampler | |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Coreslab Structures | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Santa Ana River Bridge Girders |
Material Information
| Material Type | Concrete | The concrete mix design number | 312 |
|---|---|---|---|
| The truck number from where the sample was collected | The batch plant ticket number from where the sample was collected | 76396 | |
| Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
| A detailed description of where the material sample was collected | Sample was collected from middle of concrete batch for truck 2 of continuous pour | Where the material sample would have been placed if not sampled | placed in concrete girder |
| From Lot No. | Bag Lot No. |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||