Sample Record

Owner Lab

  • G3 Quality, Incorporated - Cerritos

DIME Sample ID 2020-08-07-31

Project Information

Project IdentifiersProject ID: 211260
DEA: 072159U4
EFIS: 0715000160
DIST-CO-RTE-PM07-LA,ORA-5-0.0/1.5, 44.3/44.4
Award Date05/27/2016
Closeout Date08/01/2023
Work DescriptionCONSTRUCT HOV LANES AND MIX FLOW LANES.
Location DescriptionLOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
QA Service Level1 (Verified on 03/16/2016)

Sample Information

Sample Taken Date08/07/2020 Sample Unique Key31
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 testing08/08/2020
Sample typeQuality Control A brief description of the sample6x12 Cylinders
The quantity of what the sample constitutes6 From where was the sample collectedJob Site
First name of sampler or witnessed byJames Last name of sampler or witnessed byBurton
Title of samplerQC Field Technician Telephone number of samplerUnknown
Laboratory sample identificationSet 1 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameJobsite Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifier00-0000
Structure nameUnknown

Material Information

Material TypeConcrete The concrete mix design numberS72074
The truck number from where the sample was collectedLoad 1 The batch plant ticket number from where the sample was collected0
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleSet 1
A detailed description of where the material sample was collectedOn-Ramp Bent 3 Column A Where the material sample would have been placed if not sampledUnknown
From Lot No.Unknown Bag Lot No.Unknown

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