Sample Record
Owner Lab
- Con-Fab California, LLC
DIME Sample ID 2021-12-06-22
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Project Information
| Project Identifiers | Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169 |
|---|---|
| DIST-CO-RTE-PM | 05-SB-101-4.4/R7.7 |
| Award Date | 03/01/2021 |
| Closeout Date | Not set |
| Work Description | Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B. |
| Location Description | 101 freeway in Summerland, CA |
| QA Service Level | 1 (Verified on 05/06/2021) |
Sample Information
| Sample Taken Date | 12/06/2021 | Sample Unique Key | 22 |
|---|---|---|---|
| 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 | 12/06/2021 |
| Sample type | Quality Control | A brief description of the sample | sand |
| The quantity of what the sample constitutes | 520 grams | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Roberto | Last name of sampler or witnessed by | Reyes |
| Title of sampler | QC Technician | Telephone number of sampler | |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Con-Fab California, LLC | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name | Arroyo Paredon Bridge |
Material Information
| Material Type | Aggregate | Source Identification (SMARA, name of Pit or Job Site) | SMARA 91 15 0041 |
|---|---|---|---|
| The fabricator's/manufacturer's product name for the sample | The fabricator/manufacturer designation for the sample | ||
| The plant number | A detailed description of where the material sample was collected | silo | |
| Where the material sample would have been placed if not sampled | Primary Aggregate Nominal Size | fine | |
| The concrete mix design number | Lot number | ||
| Sublot number | Aggregate Mix Number | Not set |
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-12-06-22-1 ASTM C136-19 (Verified)