Sample Record

Owner Lab

  • G3 Quality, Inc. - Cerritos

DIME Sample ID 2020-09-25-28

Project Information

Project IdentifiersProject ID: 209141
DEA: 07215954
EFIS: 0700001835
DIST-CO-RTE-PM07-LA-5-0.0/7.6
Award Date04/24/2014
Closeout DateNot set
Work DescriptionWIDENING FREEWAY AND RECONSTRUCT OVERHEAD AND OVERCROSSING STRUCTURES
Location DescriptionLOS ANGELES COUNTY IN LA MIRADA, SANTA FE SPRINGS, NORWALK AND DOWNEY FROM ORANGE COUNTY/LOS ANGELES COUNTY LIMIT LINES TO 0.7 MILE NORTH OF ROUTE 605
QA Service Level1 (Verified on 06/02/2014)

Sample Information

Sample Taken Date09/25/2020 Sample Unique Key28
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 testing09/26/2020
Sample typeQuality Control A brief description of the samplerock and sand
The quantity of what the sample constitutes1 bag From where was the sample collectedSource
First name of sampler or witnessed byDwayne Last name of sampler or witnessed byOvalle
Title of samplerQC Field Technician Telephone number of samplerUnknown
Laboratory sample identificationMix G3-15-590-3600 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameSecurity Paving - Florance Transportation Laboratory (TL) NumberUnknown
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifier00-0000
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-19-0025
The fabricator's/manufacturer's product name for the sampleset 1 The fabricator/manufacturer designation for the sampleUnknown
The plant numberUnknown A detailed description of where the material sample was collectedBatch Plant
Where the material sample would have been placed if not sampledUnknown Primary Aggregate Nominal Size1 inch
The concrete mix design numberG3-15-590-3600 Lot numberUnknown
Sublot numberUnknown HMA Design ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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