Sample Record

Owner Lab

  • Jaxon Enterprises - Deer Creek Rock & Asphalt

DIME Sample ID 2022-09-16-42

Project Information

Project IdentifiersProject ID: 66666
DEA: APP
EFIS: 0019000052
DIST-CO-RTE-PM59---
Award DateNot set
Closeout DateNot set
Work DescriptionSpecial project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location DescriptionNot set
QA Service LevelNOT VERIFIED

Sample Information

Sample Taken Date09/16/2022 Sample Unique Key42
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 testing09/21/2022
Sample typeAggregate Prequalification Program A brief description of the sample1" x #4
The quantity of what the sample constitutes4 buckets From where was the sample collectedSource
First name of sampler or witnessed byJordan Last name of sampler or witnessed byBaker
Title of samplerQC manager Telephone number of sampler5302270982
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameDeer Creek Rock and Asphalt Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA or name of Pit)91-54-0021
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 collectedStockpile at Plant
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 Aggregate Mix NumberNot 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