Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2021-08-06-25
Project Information
Project Identifiers | Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670 |
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DIST-CO-RTE-PM | 12-ORA-405,73,405,605-9.3/24.3 |
Award Date | 11/07/2016 |
Closeout Date | Not set |
Work Description | (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP. |
Location Description | Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2 |
QA Service Level | 1 (Verified on 09/10/2015) |
Sample Information
Sample Taken Date | 08/06/2021 | Sample Unique Key | 25 |
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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 | 08/16/2021 |
Sample type | Verification | A brief description of the sample | RW 662 LCC exploded sample |
The quantity of what the sample constitutes | 1 | From where was the sample collected | Job Site |
First name of sampler or witnessed by | Nicholas | Last name of sampler or witnessed by | Hoffmann |
Title of sampler | Telephone number of sampler | 8562611057 | |
Laboratory sample identification | Linked DIME Sample ID | ||
The fabricator/manufacturer/facility name | CELL-CRETE | Transportation Laboratory (TL) Number | |
Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
Structure name |
Material Information
Material Type | Concrete Core | Detail description | Fragments of Exploded portion of Wall 662 |
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Structure names | RW 662 | Type of material | LCC Class II |
Submitted Tests
DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
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No results found. |
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |