Sample Record
Owner Lab
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2022-06-21-19
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645 |
|---|---|
| DIST-CO-RTE-PM | 08-SBD-10-0.0/13.2 |
| Award Date | 06/06/2018 |
| Closeout Date | Not set |
| Work Description | Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes |
| Location Description | LA/SBD County Line to PM 13.2 near I-15 |
| QA Service Level | 1 (Verified on 10/16/2019) |
Sample Information
| Sample Taken Date | 06/21/2022 | Sample Unique Key | 19 |
|---|---|---|---|
| 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 testing | 06/22/2022 |
| Sample type | Quality Assurance | A brief description of the sample | Concrete Cylinders |
| The quantity of what the sample constitutes | 4 | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Nathan | Last name of sampler or witnessed by | Ogbasellasie |
| Title of sampler | QA | Telephone number of sampler | |
| Laboratory sample identification | 1015-62122 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Lane Security | Transportation Laboratory (TL) Number | 1 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | 1611615 |
|---|---|---|---|
| The truck number from where the sample was collected | 10067782 | The batch plant ticket number from where the sample was collected | 3030660 |
| Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
| A detailed description of where the material sample was collected | I10 EB Haven On Ramp OH Sign Structure OS404-1 Load3 - 30 CY | Where the material sample would have been placed if not sampled | |
| From Lot No. | Bag Lot No. |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||