Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2015-04-22-1

Project Information

Project IdentifiersProject ID: 209511
DEA: 080Q7403
EFIS: 0800020456
DIST-CO-RTE-PM08-SBD-15-15.4/30.8
Award Date10/29/2013
Closeout DateNot set
Work DescriptionDesign Build project provides pavement rehabilitation (including ramps) on I-15 near Cajon Pass, CA.
Location DescriptionOn I-15 from 0.4 mile north of Kenwood Avenue to 0.3 mile south of West Hesperia OH
QA Service Level1 (Verified on 04/03/2014)

Sample Information

Sample Taken Date04/22/2015 Sample Unique Key1
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 testing04/24/2015
Sample typeVerification A brief description of the sample6X12
The quantity of what the sample constitutes2 From where was the sample collectedJob Site
First name of sampler or witnessed byJOSEPH Last name of sampler or witnessed byATAEI
Title of samplerIQA FIELD INSPECTOR Telephone number of samplerUnknown
Laboratory sample identification878-15 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameCollected at jobsite Transportation Laboratory (TL) NumberLCB 15
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierSTA 491 80 TO 451 10
Structure nameNB SEG 2 LANE 4 AND 5 SHOULDER

Material Information

Material TypeConcrete The concrete mix design number1202-8
The truck number from where the sample was collected28 The batch plant ticket number from where the sample was collected68
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedTRUCK Where the material sample would have been placed if not sampledNot set
From Lot No.Not set Bag Lot No.Not set

Submitted Tests

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

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Test File Attachments