Sample Record

Owner Lab

  • CT HQ - Sacramento Materials Management Branch Field Office

DIME Sample ID 2021-02-03-35

Project Information

Project Identifiers
DEA: No Project
DIST-CO-RTE-PM---
Award DateNot set
Closeout Date11/01/2022
Work DescriptionSpecial project identifier for material not associated with a project
Location DescriptionNot set
QA Service LevelNOT VERIFIED

Sample Information

Sample Taken Date02/03/2021 Sample Unique Key35
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 testing02/03/2021
Sample typeVerification A brief description of the sample1
The quantity of what the sample constitutes1 From where was the sample collectedDistributor
First name of sampler or witnessed byabc Last name of sampler or witnessed bytester
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility name1 Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeHot Mix Asphalt HMA TypeType A HMA
HMA Grading3/4 inch Lot number
Sublot number HMA Mix NumberNot set

JMF Information

Verification IDJMF3513-2020-133 Date Created06/02/2020
JMF Submittal IDJMF3511-6-2020-206 JMF StatusSubmittal Accepted for Verification
Producer Mix ID123456789 Authorized DateN/A

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.

Sample File Attachments

File NameExtensionDate UploadedActions
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Test File Attachments