Sample Record
Owner Lab
- CT D01 - District 1 Materials Laboratory
DIME Sample ID 2021-10-26-23
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Project Information
| Project Identifiers | Project ID: 993322 DEA: 010L4204 EFIS: 0122000008 |
|---|---|
| DIST-CO-RTE-PM | 01-MEN,MEN/MEN-101-4/6, 4.0/6.0 |
| Award Date | 08/23/2021 |
| Closeout Date | Not set |
| Work Description | Landslide Repair near Commisky |
| Location Description | Not set |
| QA Service Level | 1 (Verified on 10/11/2021) |
Sample Information
| Sample Taken Date | 10/26/2021 | Sample Unique Key | 23 |
|---|---|---|---|
| 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 | 10/27/2021 |
| Sample type | Department Acceptance | A brief description of the sample | pea gravel |
| The quantity of what the sample constitutes | 1 bag | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Ken | Last name of sampler or witnessed by | Poulter |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 21-205 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Shamrock Concrete | Transportation Laboratory (TL) Number | 930512 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Aggregate | Source Identification (SMARA, name of Pit or Job Site) | unknown |
|---|---|---|---|
| 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 collected | stockpile | |
| Where the material sample would have been placed if not sampled | Primary Aggregate Nominal Size | 3/8 inch | |
| The concrete mix design number | Lot number | ||
| Sublot number | Aggregate Mix Number | Not set |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-10-26-23-1 CTM 211-May 2010 (Verified)