Sample Record

Owner Lab

  • Kleinfelder, Incorporated - Los Angeles

DIME Sample ID 2022-02-01-10

Project Information

Project IdentifiersProject ID: 214573
DEA: 073096U4
EFIS: 0719000091
DIST-CO-RTE-PM07-LA-210-R0.0/R9.7
Award Date04/03/2020
Closeout DateNot set
Work DescriptionPLACE CONCRETE PAVEMENT, BARRIER, HMA, DRAINAGE, AND ELECTRICAL.
Location DescriptionLOS ANGELES COUNTY IN LOS ANGELES FROM INTERSTATE 5 TO WHEATLAND AVENUE UNDERCROSSING
QA Service Level1 (Verified on 06/05/2020)

Sample Information

Sample Taken Date02/01/2022 Sample Unique Key10
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 testing02/02/2022
Sample typePer Request A brief description of the sampleA set of 2 LCB RS cylinders
The quantity of what the sample constitutes130 CY From where was the sample collectedManufacturer
First name of sampler or witnessed byMike Last name of sampler or witnessed byDorsch
Title of sampler Telephone number of sampler9098335780
Laboratory sample identification22-0159 Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving Burbank Batch Plant Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number57030SL
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected8921
Concrete batch plantVanguard at 57 Freeway The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedconcrete sample from wheel barrow Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments