Sample Record

Owner Lab

  • CT D07 Plant Services

DIME Sample ID 2022-01-26-20

Project Information

Project IdentifiersProject ID: 214620
DEA: 07309304
EFIS: 0714000281
DIST-CO-RTE-PM07-LA-210,405,605-Various
Award Date03/18/2020
Closeout Date07/26/2022
Work DescriptionREINFORCE STRUCTURAL CONCRETE BRIDGE AND PLACE RHMA SHOULDER PAVING.
Location DescriptionLOS ANGELES COUNTY AT VARIOUS LOCATIONS
QA Service Level1 (Verified on 04/15/2020)

Sample Information

Sample Taken Date01/26/2022 Sample Unique Key20
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing02/02/2022
Sample typeAcceptance A brief description of the sample1x4 pcc aggregate
The quantity of what the sample constitutes50 CY From where was the sample collectedManufacturer
First name of sampler or witnessed byVictor Last name of sampler or witnessed byPham
Title of samplerTET Telephone number of sampler2137924794
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCemex Transportation Laboratory (TL) NumberC-0126A1
Inspector Lot Number from the Transportation Laboratory (TL) Form5749 Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-36-0106::WHITE MOUNTAIN QUARRY
The fabricator's/manufacturer's product name for the samplePCC mix The fabricator/manufacturer designation for the samplemix 1612109
The plant numberLos Angeles A detailed description of where the material sample was collectedPlant Stockpile
Where the material sample would have been placed if not sampledbarrier Primary Aggregate Nominal Size1 inch
The concrete mix design number1612109 Lot number
Sublot number HMA Design ID

Submitted Tests

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