Sample Record

Owner Lab

  • CT D07 - Materials Field Laboratory, Unit 1953

DIME Sample ID 2022-03-30-1

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 Date06/06/2024
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 Date03/30/2022 Sample Unique Key1
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 testing03/30/2022
Sample typeDepartment Acceptance A brief description of the sampleConcrete
The quantity of what the sample constitutes10 From where was the sample collectedManufacturer
First name of sampler or witnessed byChad Last name of sampler or witnessed byChotibhongs
Title of samplerMREA Telephone number of sampler213-817-0387
Laboratory sample identification22-0648 Linked DIME Sample ID
The fabricator/manufacturer/facility nameRobertsons - North Hollywood 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 numberSC425N49
The truck number from where the sample was collected1698 The batch plant ticket number from where the sample was collected101C6557213
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedDischarge from concrete truck into wheelbarrow. 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
2022-03-30-1-1CTM 518-June 2010: Method of Test for Unit Weight of Fresh ConcreteChad Chotibhongs, CT D07 - Materials Field Laboratory, Unit 195303/30/2022Chad Chotibhongs
Yes
03/30/2022

Sample File Attachments

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Test File Attachments


DIME Test ID: 2022-03-30-1-1 CTM 518-June 2010 (Verified)