Sample Record

Owner Lab

  • CT HQ - Sacramento Hot Mix Asphalt Laboratory

DIME Sample ID 2021-01-29-3

Project Information

Project IdentifiersProject ID: 99999
DEA: 0322222
DIST-CO-RTE-PM03-SAC,OMG-888,99,80-0.6-0.6
Award DateNot set
Closeout DateNot set
Work DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
QA Service Level (Verified on 04/05/2013)

Sample Information

Sample Taken Date01/29/2021 Sample Unique Key3
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 testing01/29/2021
Sample typeVerification A brief description of the sample3 bins (1/4", 3/8", 1/2", mineral filler) 2 bags per bin
The quantity of what the sample constitutes3 bags From where was the sample collectedSource
First name of sampler or witnessed byjohn Last name of sampler or witnessed bydoe
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameSyar Industries Inc Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA, name of Pit or Job Site)91-48-0002::LAKE HERMAN QUARRY
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedHot bins
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size1/2 inch
The concrete mix design number Lot number
Sublot number Aggregate Mix NumberNot set

JMF Information

Verification IDJMF3513-2021-15 Date Created01/29/2021
JMF Submittal IDJMF3511-208-2021-20 JMF StatusSubmittal Accepted for Verification
Producer Mix IDtest-dry-run Authorized DateN/A

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