Sample Record
Owner Lab
- CT D04 - DME / District Lab
DIME Sample ID 2021-09-09-43
Project Information
| Project Identifiers | Project ID: 214601 DEA: 041J5694 EFIS: 0419000313 |
|---|---|
| DIST-CO-RTE-PM | 04--- |
| Award Date | Not set |
| Closeout Date | Not set |
| Work Description | Not set |
| Location Description | Not set |
| QA Service Level | 1 (Verified on 04/08/2022) |
Sample Information
| Sample Taken Date | 09/09/2021 | Sample Unique Key | 43 |
|---|---|---|---|
| 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 | 09/14/2021 |
| Sample type | Verification | A brief description of the sample | 16 Mohes of RHMA-G |
| The quantity of what the sample constitutes | 16 Boxes | From where was the sample collected | Source |
| First name of sampler or witnessed by | Jacob | Last name of sampler or witnessed by | Cruz |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Hanson Sunol | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Hot Mix Asphalt | HMA Type | RHMA-G |
|---|---|---|---|
| HMA Grading | 1/2 inch | Lot number | |
| Sublot number | JMF Verification ID | JMF3513-2021-82 |