Sample Record

Owner Lab

  • CT D02 - North Region Materials Lab

DIME Sample ID 2021-10-07-33

Sample is locked from editing. info

Project Information

Project IdentifiersProject ID: 215403
DEA: 021H4004
EFIS: 0216000042
DIST-CO-RTE-PM02-SIS-5-R8.3
Award Date03/02/2021
Closeout DateNot set
Work DescriptionPLACE STRUCTURAL CONCRETE BRIDGE DECK AND BARRIER AND PLACE HMA.
Location DescriptionSISKIYOU COUNTY NEAR MOUNT SHASTA AT AZALEA ROAD OVERCROSSING
QA Service Level1 (Verified on 01/07/2021)

Sample Information

Sample Taken Date10/07/2021 Sample Unique Key33
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 testing10/09/2021
Sample typeAcceptance A brief description of the sampleClass 2 Aggregate Base
The quantity of what the sample constitutes2 bags for unit weight From where was the sample collectedManufacturer
First name of sampler or witnessed byKarl Last name of sampler or witnessed byHuntman
Title of samplerJET Telephone number of sampler
Laboratory sample identificationD78955 Linked DIME Sample ID
The fabricator/manufacturer/facility nameMountain Gate Quarry Transportation Laboratory (TL) Number853081
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-45-0001
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedStockpile
Where the material sample would have been placed if not sampled02 SIS 5 Primary Aggregate Nominal Size3/4 inch
The concrete mix design number Lot numberUnknown
Sublot numberUnknown HMA Design ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-10-07-33-1CTM 212-May 2010: Method of Test for Unit Weight of AggregateTerry McCormickCT D02 - North Region Materials Lab10/11/2021Darrell Valasek
Yes
10/21/2021