Sample Record
Owner Lab
- CT D07 - Materials Field Laboratory, Unit 1953
DIME Sample ID 2021-12-04-4
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Project Information
| Project Identifiers | Project ID: 215690 DEA: 074W9504 EFIS: 0720000200 |
|---|---|
| DIST-CO-RTE-PM | 07-LA-91-R12.1/R20.7 |
| Award Date | 06/02/2021 |
| Closeout Date | 05/26/2022 |
| Work Description | INDIVIDUAL SLAB REPLACEMENT. |
| Location Description | LOS ANGELES COUNTY IN LONG BEACH AND CERRITOS FROM ATLANTIC AVENUE UNDERCROSSING TO THE ORANGE COUNTY LINE |
| QA Service Level | 1 (Verified on 08/16/2021) |
Sample Information
| Sample Taken Date | 12/04/2021 | Sample Unique Key | 4 |
|---|---|---|---|
| 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 | 12/04/2021 |
| Sample type | Department Acceptance | A brief description of the sample | WB91 Downey off ramp |
| The quantity of what the sample constitutes | 200 cy | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Sopheak | Last name of sampler or witnessed by | Chong |
| Title of sampler | TE | Telephone number of sampler | 12138170174 |
| Laboratory sample identification | 21-2889 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Peterson Chase | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | 21-2889 | |
| Structure name | WB91 Downey off ramp |
Material Information
| Material Type | Concrete | The concrete mix design number | CTS-65-EHI |
|---|---|---|---|
| The truck number from where the sample was collected | 10 | The batch plant ticket number from where the sample was collected | NA |
| Concrete batch plant | SHORT LOAD CONCRETE INC | The fabricator/manufacturer designation for the sample | Peterson Chase |
| A detailed description of where the material sample was collected | WB91 Downey off ramp | Where the material sample would have been placed if not sampled | SHORT LOAD CONCRETE INC |
| From Lot No. | NA | Bag Lot No. | NA |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| 2021-12-04-4-1 | CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete | Sopheak Chong, CT D07 - Materials Field Laboratory, Unit 1953 | 12/07/2021 | Sopheak Chong | No | Info |
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-12-04-4-1 CTM 524-March 2013