Sample Record

Owner Lab

  • CT D07 Plant Services

DIME Sample ID 2022-05-10-3

Project Information

Project IdentifiersProject ID: 211260
DEA: 072159U4
EFIS: 0715000160
DIST-CO-RTE-PM07-LA,ORA-5-0.0/1.5, 44.3/44.4
Award Date05/27/2016
Closeout DateNot set
Work DescriptionCONSTRUCT HOV LANES AND MIX FLOW LANES.
Location DescriptionLOS ANGELES AND ORANGE COUNTIES IN BUENA PARK, LA MIRADA, CERRITOS AND SANTA FE SPRINGS FROM ARTESIA BOULEVARD UNDERCROSSING TO NORTH FORK COYOTE CREEK
QA Service Level1 (Verified on 03/16/2016)

Sample Information

Sample Taken Date05/10/2022 Sample Unique Key3
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 testing05/10/2022
Sample typeQuality Assurance A brief description of the sample1x 4 Pcc Aggregate
The quantity of what the sample constitutes400 From where was the sample collectedManufacturer
First name of sampler or witnessed byZaid Last name of sampler or witnessed byAbdelkhaliq
Title of samplerTET Telephone number of sampler7146441268
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameSecurity Paving batch plant Transportation Laboratory (TL) Number1001
Inspector Lot Number from the Transportation Laboratory (TL) Form1001 Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-13-0098
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 collectedconniver belt
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size1 inch
The concrete mix design number Lot number
Sublot number HMA Design ID

Submitted Tests

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