Sample Record
Owner Lab
- CT D07 Plant Services
DIME Sample ID 2022-03-02-76
Project Information
| Project Identifiers | Project ID: 214620 DEA: 07309304 EFIS: 0714000281 |
|---|---|
| DIST-CO-RTE-PM | 07-LA-210,405,605-Various |
| Award Date | 03/18/2020 |
| Closeout Date | 07/26/2022 |
| Work Description | REINFORCE STRUCTURAL CONCRETE BRIDGE AND PLACE RHMA SHOULDER PAVING. |
| Location Description | LOS ANGELES COUNTY AT VARIOUS LOCATIONS |
| QA Service Level | 1 (Verified on 04/15/2020) |
Sample Information
| Sample Taken Date | 03/02/2022 | Sample Unique Key | 76 |
|---|---|---|---|
| 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 testing | 03/02/2022 |
| Sample type | Acceptance | A brief description of the sample | 3/8 |
| The quantity of what the sample constitutes | 40 | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Zaid | Last name of sampler or witnessed by | Abdelkhaliq |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | CEMEX LA | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Aggregate | Source Identification (SMARA or name of Pit) | 91-36-0106 |
|---|---|---|---|
| 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 collected | Conveyor Belt | |
| Where the material sample would have been placed if not sampled | Primary Aggregate Nominal Size | 3/8 inch | |
| The concrete mix design number | Lot number | ||
| Sublot number | HMA Design ID |