Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2021-11-19-22

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 Key22
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 testing12/22/2021
Sample typeAcceptance A brief description of the samplePCC cylinders
The quantity of what the sample constitutes45 From where was the sample collectedJob Site
First name of sampler or witnessed byAntonio Last name of sampler or witnessed byPicazo
Title of samplerTEC ASR Telephone number of sampler
Laboratory sample identification21-0434 Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving batch plant Transportation Laboratory (TL) Number21111901
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design numberG3-17-STR-006F
The truck number from where the sample was collected5 The batch plant ticket number from where the sample was collectedNA
Concrete batch plantSecurity Paving 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 sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-11-19-22-1CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete CylindersArnold TruongCT D07 - Materials Field Laboratory, Unit 195312/17/2021Robert Achuela
No
Info

Sample File Attachments

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Test File Attachments


DIME Test ID: 2021-11-19-22-1 CTM 521-June 2020