Sample Record
Owner Lab
- CT D04 - DME / District Lab
DIME Sample ID 2021-08-20-46
Project Information
| Project Identifiers | Project ID: 214114 DEA: 040A5394 EFIS: 0418000244 |
|---|---|
| DIST-CO-RTE-PM | 04-SOL-80,12-11.4/12.8, 2.1/2.8 |
| Award Date | Not set |
| Closeout Date | Not set |
| Work Description | Widen EB SR-12 Connector, Construct 3 ramps & 2 box girder bridges, remove existing bridge, etc. |
| Location Description | I-80/I-680/Route 12 Interchange |
| QA Service Level | 1 (Verified on 04/23/2019) |
Sample Information
| Sample Taken Date | 08/20/2021 | Sample Unique Key | 46 |
|---|---|---|---|
| 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 | 08/20/2021 |
| Sample type | Verification | A brief description of the sample | 1 Bag of RAP |
| The quantity of what the sample constitutes | 1 bag | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | (Plant QC Rep) (Plant | Last name of sampler or witnessed by | Rep) |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Syar Valejo | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Reclaimed Asphalt Pavement | RAP Source | Syar Lake Herman |
|---|---|---|---|
| Aggregate Size | Aggregate Source | ||
| RAP Stockpile | Stockpile Size (tons) | ||
| JMF Verification ID | JMF3513-2021-78 |