Sample Record

Owner Lab

  • CT - Southern Regional Laboratory

DIME Sample ID 2020-10-12-16

Sample is locked from editing.

Project Information

Project IdentifiersProject ID: 213707
DEA: 081C38U4
EFIS: 0817000196
DIST-CO-RTE-PM08-RIV-10-6.7/R25.1
Award DateNot set
Closeout DateNot set
Work DescriptionRemove concrete pavement and base, and place HMA and JPCP
Location DescriptionROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
QA Service Level1 (Verified on 01/09/2020)

Sample Information

Sample Taken Date10/12/2020 Sample Unique Key16
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 testing10/14/2020
Sample typeQuality Control A brief description of the sample6x12
The quantity of what the sample constitutes6 From where was the sample collectedJob Site
First name of sampler or witnessed byfattah Last name of sampler or witnessed bykazi
Title of samplerqa Telephone number of sampler
Laboratory sample identification1012-10 Linked DIME Sample ID
The fabricator/manufacturer/facility namecoffman Transportation Laboratory (TL) Number10
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number1906-23
The truck number from where the sample was collected4 The batch plant ticket number from where the sample was collected105
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedOn Job Site at Concrete Truck Where the material sample would have been placed if not sampledSTA 24550 FS
From Lot No. Bag Lot No.

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