Sample Record

Owner Lab

  • Veleroo - Coolidge

DIME Sample ID 2021-03-01-36

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 Date03/01/2021 Sample Unique Key36
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 testing03/01/2021
Sample typeQuality Control A brief description of the sample23
The quantity of what the sample constitutes1234 From where was the sample collectedJob Site
First name of sampler or witnessed by23 Last name of sampler or witnessed by23
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility name32weq Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAsphalt Binder Performance GradePG 64-10
Modified Lot number
Sublot number Tank number
Time of sample HMA Supplier
Certified Asphalt SupplierErgon Asphalt & Emulsions Incorporated - Las Vegas NV MultigradeNot set
Multigrade TypeNot set Asphalt Binder Mix NumberNot set

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