Sample Record

Owner Lab

  • CT D07 - Plant Services

DIME Sample ID 2022-01-06-55

Project Information

Project IdentifiersProject ID: 214573
DEA: 073096U4
EFIS: 0719000091
DIST-CO-RTE-PM07-LA-210-R0.0/R9.7
Award DateNot set
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 Date01/06/2022 Sample Unique Key55
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 testing01/06/2022
Sample typeQuality Assurance A brief description of the sample1 x 4 PCC Aggregate
The quantity of what the sample constitutes250 From where was the sample collectedFabricator
First name of sampler or witnessed byGERARDO Last name of sampler or witnessed byZUBIETA
Title of samplerTransportation Engineer Telephone number of sampler2137924795
Laboratory sample identificationC-924023 Linked DIME Sample ID
The fabricator/manufacturer/facility nameFlat Iron Transportation Laboratory (TL) Number5554
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-19-0023::DURBIN
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedstock pile
Where the material sample would have been placed if not sampledPCC SLAB Primary Aggregate Nominal Size1 inch
The concrete mix design numberFWI 3018-A1 Lot number
Sublot number Aggregate Mix NumberNot set

Submitted Tests

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