Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2021-10-28-38

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 Date10/28/2021 Sample Unique Key38
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 testing11/01/2021
Sample typeAcceptance A brief description of the samplePCC cylinders
The quantity of what the sample constitutesNK From where was the sample collectedJob Site
First name of sampler or witnessed byOmid Last name of sampler or witnessed byKhazari
Title of samplerAssistant SR Telephone number of sampler
Laboratory sample identification21-0396 Linked DIME Sample ID
The fabricator/manufacturer/facility nameRobertsons Ready Mix Transportation Laboratory (TL) Number21102801
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design numberSC675B38
The truck number from where the sample was collected6 The batch plant ticket number from where the sample was collected855404
Concrete batch plantRobertsons Ready Mix The fabricator/manufacturer designation for the sampleRobertsons Ready Mix
A detailed description of where the material sample was collectedChute Where the material sample would have been placed if not sampledFooting
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments