Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2021-01-09-4

Project Information

Project IdentifiersProject ID: 213746
DEA: 080Q75U4
EFIS: 0817000114
DIST-CO-RTE-PM08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Award Date04/18/2019
Closeout Date06/28/2022
Work DescriptionREPLACEMENT OF TWO OUTSIDE LANES AND CONCRETE SLABS
Location DescriptionNot set
QA Service Level1 (Verified on 06/17/2019)

Sample Information

Sample Taken Date01/09/2021 Sample Unique Key4
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 testing01/20/2021
Sample typeQuality Assurance A brief description of the sampleCONCRETE CYLINDERS
The quantity of what the sample constitutesCONCRETE CYLINDERS From where was the sample collectedJob Site
First name of sampler or witnessed byNA Last name of sampler or witnessed byNA
Title of samplerRMA Telephone number of sampler
Laboratory sample identification999-109B Linked DIME Sample ID
The fabricator/manufacturer/facility nameShort Load Concrete Inc Transportation Laboratory (TL) Number999-109B
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design numberCTS-30-RAM
The truck number from where the sample was collectedNA The batch plant ticket number from where the sample was collectedNA
Concrete batch plantVOLUMETRIC TRUCK The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedSITE Where the material sample would have been placed if not sampledNA
From Lot No. Bag Lot No.

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