Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2021-10-09-11

Project Information

Project IdentifiersProject ID: 214524
DEA: 07304504
EFIS: 0714000067
DIST-CO-RTE-PM07-LA-57-R0.0/R4.5
Award Date06/11/2020
Closeout DateNot set
Work DescriptionCONCRETE PAVEMENT, CONCRETE BARRIER, AND ELECTRICAL WORK.
Location DescriptionLOS ANGELES COUNTY IN DIAMOND BAR AND CITY OF INDUSTRY FROM ORANGE COUNTY LINE TO ROUTE 57/60 SEPARATION
QA Service Level1 (Verified on 08/12/2020)

Sample Information

Sample Taken Date10/09/2021 Sample Unique Key11
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 testing10/10/2021
Sample typeAcceptance A brief description of the sampleJPCPRS
The quantity of what the sample constitutes400CY From where was the sample collectedJob Site
First name of sampler or witnessed byChad Last name of sampler or witnessed byChotibhongs
Title of samplerMREA Telephone number of sampler213-817-0387
Laboratory sample identification21-2586 Linked DIME Sample ID
The fabricator/manufacturer/facility nameVanguard at the 57 Freeway Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure nameCA 57 NB Brea Canyon

Material Information

Material TypeConcrete The concrete mix design number61030SL
The truck number from where the sample was collected1 The batch plant ticket number from where the sample was collectedNA
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedChute discharge into wheel barrel Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-10-09-11-1CTM 523-May 2020: Method of Test for Flexural Strength of ConcreteChad Chotibhongs, CT D07 - Materials Field Laboratory, Unit 195311/06/2021Chad Chotibhongs
No
Info

Sample File Attachments

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Test File Attachments


DIME Test ID: 2021-10-09-11-1 CTM 523-May 2020