Sample Record
Owner Lab
- CT D07 - Materials Field Laboratory, Unit 1953
DIME Sample ID 2021-11-19-7
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 211260 DEA: 072159U4 EFIS: 0715000160 |
|---|---|
| DIST-CO-RTE-PM | 07-LA,ORA-5-0.0/1.5, 44.3/44.4 |
| Award Date | 05/27/2016 |
| Closeout Date | 08/01/2023 |
| Work Description | CONSTRUCT HOV LANES AND MIX FLOW LANES. |
| Location Description | LOS 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 Level | 1 (Verified on 03/16/2016) |
Sample Information
| Sample Taken Date | 11/19/2021 | Sample Unique Key | 7 |
|---|---|---|---|
| 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 | 11/22/2021 |
| Sample type | Acceptance | A brief description of the sample | PCC cylinders |
| The quantity of what the sample constitutes | 300 cu yds | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Antonio | Last name of sampler or witnessed by | Picazo |
| Title of sampler | Assistant SR | Telephone number of sampler | 3233136152 |
| Laboratory sample identification | 21-0434 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Security Paving company | Transportation Laboratory (TL) Number | 21111901 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | 21111901 | Structure unique identifier | |
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | 63-17-STR-006F |
|---|---|---|---|
| The truck number from where the sample was collected | The batch plant ticket number from where the sample was collected | 855207 | |
| Concrete batch plant | Security Paving batch plant | The fabricator/manufacturer designation for the sample | |
| A detailed description of where the material sample was collected | Chute | Where the material sample would have been placed if not sampled | Frame 2 |
| From Lot No. | Bag Lot No. |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||