Sample Record

Owner Lab

  • CT D07 - Plant Services

DIME Sample ID 2022-04-27-16

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 Date04/27/2022 Sample Unique Key16
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 testing04/28/2022
Sample typeQuality Assurance A brief description of the sampleRECYCLED LEAN BASE AGG FOR LCB
The quantity of what the sample constitutes450 CY From where was the sample collectedJob Site
First name of sampler or witnessed bySeifu Last name of sampler or witnessed byMersha
Title of samplerTET Telephone number of sampler2132164406
Laboratory sample identificationSM034-22 Linked DIME Sample ID
The fabricator/manufacturer/facility nameFlatiron Plant - Paxton off-Ramp 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, name of Pit or Job Site)LB Crushing: CMB / CL 2 BASE
The fabricator's/manufacturer's product name for the sampleCMB stockpile 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 numberLCB-3215-03 Lot number
Sublot number Aggregate Mix NumberNot set

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
2022-04-27-16-1CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse AggregatesSeifu Mersha, CT D07 - Plant Services04/28/2022Seifu Mersha
Yes
05/03/2022

Sample File Attachments

File NameExtensionDate UploadedActions
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Test File Attachments


DIME Test ID: 2022-04-27-16-1 CTM 202-November 2011 (Verified)