Sample Record

Owner Lab

  • CT D10 - District Materials Laboratory

DIME Sample ID 2022-01-10-37

Project Information

Project IdentifiersProject ID: 215417
DEA: 101K9304
EFIS: 1020000014
DIST-CO-RTE-PM10-SJ-VAR,580-VAR
Award Date04/29/2021
Closeout Date06/27/2022
Work DescriptionBRIDGE DECKS INVESTIGATION AND REHABILITATION IN AND NEAR TRACY
Location DescriptionSJ CTY IN & NEAR TRACY FROM GAFFERY RD TO EAST MIDWAY
QA Service Level1 (Verified on 01/04/2021)

Sample Information

Sample Taken Date01/10/2022 Sample Unique Key37
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 testing01/11/2022
Sample typeVerification A brief description of the sample1/2" HMA-A
The quantity of what the sample constitutes4 bags, 16 boxes From where was the sample collectedManufacturer
First name of sampler or witnessed byMike Last name of sampler or witnessed byCozad
Title of samplerLab Technician Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID22-J-001
The fabricator/manufacturer/facility nameTeichert Materials Vernalis Transportation Laboratory (TL) Number034276
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeHot Mix Asphalt HMA TypeType A HMA
HMA Grading1/2 inch Lot number
Sublot number JMF Verification ID

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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