Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2022-06-22-26

Project Information

Project IdentifiersProject ID: 213707
DEA: 081C38U4
EFIS: 0817000196
DIST-CO-RTE-PM08-RIV-10-6.7/R25.1
Award Date11/26/2019
Closeout Date11/01/2023
Work DescriptionRemove concrete pavement and base, and place HMA and JPCP
Location DescriptionROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
QA Service Level1 (Verified on 01/09/2020)

Sample Information

Sample Taken Date06/22/2022 Sample Unique Key26
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 testing06/24/2022
Sample typeQuality Assurance A brief description of the sample6x12
The quantity of what the sample constitutes6` From where was the sample collectedJob Site
First name of sampler or witnessed byZacharia Last name of sampler or witnessed byRoush
Title of samplerQA Inspector Telephone number of sampler
Laboratory sample identification1012-70RR Linked DIME Sample ID
The fabricator/manufacturer/facility namecoffman Transportation Laboratory (TL) Number70RR
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number1906-17
The truck number from where the sample was collected69 The batch plant ticket number from where the sample was collected12
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedRiv10-A Sta 6750 WB Lane 3 and 4 Near WB Highland Springs Off Ramp LOAD 12 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
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Sample File Attachments

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Test File Attachments