Sample Record
Owner Lab
- CT D03 - Olivehurst Northern Regional Laboratory
DIME Sample ID 2021-04-05-33
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 214764 DEA: 032H6404 EFIS: 0317000167 |
|---|---|
| DIST-CO-RTE-PM | 03-SAC-12,160-0.4/0.9,L10.5/R0.2 |
| Award Date | 05/20/2020 |
| Closeout Date | 05/11/2022 |
| Work Description | MODIFY SIGNAL AND LIGHTING SYSTEM, PLACE RHMA AND ROADWAY EXCAVATION. |
| Location Description | SACRAMENTO COUNTY NEAR RIO VISTA ON ROUTE 12 FROM 0.6 MILE EAST OF SACRAMENTO RIVER BRIDGE TO 5.2 MILES WEST OF MOKELUMNE RIVER BRIDGE AND ON ROUTE 160 FROM 3.6 MILES NORTH OF THREE MILE SLOUGH BRIDGE TO 2.7 MILES SOUTH OF CIRCLE DRIVE |
| QA Service Level | 1 (Verified on 03/24/2020) |
Sample Information
| Sample Taken Date | 04/05/2021 | Sample Unique Key | 33 |
|---|---|---|---|
| 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 testing | 04/06/2021 |
| Sample type | Verification | A brief description of the sample | High Natural - Crumb Rubber Modifier |
| The quantity of what the sample constitutes | JMF Verification | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | George Reed Personnel (SAMPLER) | Last name of sampler or witnessed by | Moses Onejeme (WITNESS) |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | JMF21-011 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | George Reed Inc - Clements Batch Plant | Transportation Laboratory (TL) Number | C123456 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Crumb Rubber Modifier | CRM Type | High Natural |
|---|---|---|---|
| Crumb Rubber Modifier Mix Number | Not set |
JMF Information
| Verification ID | JMF3513-2021-50 | Date Created | 05/06/2021 |
|---|---|---|---|
| JMF Submittal ID | JMF3511-23-2021-62 | JMF Status | Submittal Authorized For Use |
| Producer Mix ID | 2021-CLM-004R-VSS | Authorized Date | 09/10/2021 |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||