Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2021-11-19-7

Project Information

Project IdentifiersProject ID: 211260
DEA: 072159U4
EFIS: 0715000160
DIST-CO-RTE-PM07-LA,ORA-5-0.0/1.5, 44.3/44.4
Award Date05/27/2016
Closeout DateNot set
Work DescriptionCONSTRUCT HOV LANES AND MIX FLOW LANES.
Location DescriptionLOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
QA Service Level1 (Verified on 03/16/2016)

Sample Information

Sample Taken Date11/19/2021 Sample Unique Key7
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 testing11/22/2021
Sample typeAcceptance A brief description of the samplePCC cylinders
The quantity of what the sample constitutes300 cu yds From where was the sample collectedJob Site
First name of sampler or witnessed byAntonio Last name of sampler or witnessed byPicazo
Title of samplerAssistant SR Telephone number of sampler3233136152
Laboratory sample identification21-0434 Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving company Transportation Laboratory (TL) Number21111901
Inspector Lot Number from the Transportation Laboratory (TL) Form21111901 Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number63-17-STR-006F
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected855207
Concrete batch plantSecurity Paving batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedChute Where the material sample would have been placed if not sampledFrame 2
From Lot No. Bag Lot No.

Submitted Tests

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