Sample Record
Owner Lab
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2021-10-12-12
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Project Information
| Project Identifiers | Project ID: 215188 DEA: 080F5434 EFIS: 0817000239 Permit Numbers: 0823NMC0369 |
|---|---|
| DIST-CO-RTE-PM | 08-RIV-I-15,SR-91-6.1-7.6 |
| Award Date | 03/11/2020 |
| Closeout Date | 06/05/2024 |
| Work Description | I-15 ELC: 15/91 Express Lanes Connector Project (ELC) |
| Location Description | Junction of I-15 and SR-91 in Corona, CA |
| QA Service Level | 1 (Verified on 09/16/2020) |
Sample Information
| Sample Taken Date | 10/12/2021 | Sample Unique Key | 12 |
|---|---|---|---|
| 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 testing | 10/13/2021 |
| Sample type | Annual Source Testing | A brief description of the sample | concrete cylinders |
| The quantity of what the sample constitutes | 9 | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Zachariah | Last name of sampler or witnessed by | Roush |
| Title of sampler | Consultant | Telephone number of sampler | |
| Laboratory sample identification | 1026-03 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Cemex | Transportation Laboratory (TL) Number | 3 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | 1419984 |
|---|---|---|---|
| The truck number from where the sample was collected | 10066592 | The batch plant ticket number from where the sample was collected | 2901072 |
| Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
| A detailed description of where the material sample was collected | A Line Station 420 25 | Where the material sample would have been placed if not sampled | |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-10-12-12-1 ASTM C39-21 (Verified)
DIME Test ID: 2021-10-12-12-2 ASTM C39-21 (Verified)