Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2021-12-13-32

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 Date12/13/2021 Sample Unique Key32
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 testing12/13/2021
Sample typeAcceptance A brief description of the sampleNB I-5 Mainline lane#1 sta.73+85
The quantity of what the sample constitutes700 cy From where was the sample collectedJob Site
First name of sampler or witnessed bySopheak Last name of sampler or witnessed byChong
Title of samplerTE Telephone number of sampler12138170174
Laboratory sample identification21-2953 Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving batch plant Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier21-2953
Structure nameNB I5 mainline

Material Information

Material TypeConcrete The concrete mix design numberG3-19-PCC-001
The truck number from where the sample was collected10 The batch plant ticket number from where the sample was collected21044
Concrete batch plantSecurity Paving Company The fabricator/manufacturer designation for the sampleSECURITY PAVING
A detailed description of where the material sample was collectedNB I-5 Mainline lane1 Where the material sample would have been placed if not sampledjobsite
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2021-12-13-32-1CTM 523-May 2020: Method of Test for Flexural Strength of ConcreteSopheak ChongCT D07 - Materials Field Laboratory, Unit 195301/10/2022Sopheak Chong
No
Info

Sample File Attachments

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Test File Attachments


DIME Test ID: 2021-12-13-32-1 CTM 523-May 2020