Sample Record

Owner Lab

  • CT D07 Plant Services

DIME Sample ID 2022-01-20-65

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 Date01/20/2022 Sample Unique Key65
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 testing01/21/2022
Sample typeAcceptance A brief description of the sampleCoarse and fine aggregate
The quantity of what the sample constitutesTwo Bags From where was the sample collectedManufacturer
First name of sampler or witnessed byBaher Last name of sampler or witnessed byFakhoury
Title of sampler Telephone number of sampler2137937180
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameRobertson's Irwindale Transportation Laboratory (TL) Number
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)Robertsons Corona
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 collectedConveyor Belt
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size1 inch
The concrete mix design numberSC270N31 Lot number
Sublot number HMA Design ID

Submitted Tests

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