Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2015-07-07-2

Project Information

Project IdentifiersProject ID: 208862
DEA: 080K7104
EFIS: 0800000366
DIST-CO-RTE-PM08-SBD-15,215-14.0/R16.4,16.0/17.8
Award Date11/13/2012
Closeout Date02/13/2017
Work DescriptionI-15/I-215 Interchange Improvements (Devore)
Location DescriptionOn I-15 from 0.8 mile south of Glen Helen Parkway UC to 1.4 mile north of Kenwood Ave UC And On I-215 from 1.2 mile south of Devore Road OC to the I-15 junction
QA Service Level1 (Verified on 06/10/2013)

Sample Information

Sample Taken Date07/07/2015 Sample Unique Key2
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 testing07/07/2015
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes4 From where was the sample collectedJob Site
First name of sampler or witnessed byRavinder Last name of sampler or witnessed bySingh
Title of samplerASR Telephone number of samplerUnknown
Laboratory sample identification868-09B Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameHolliday Transportation Laboratory (TL) Number150709B
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierUnknown
Structure nameBridge 22 Deck

Material Information

Material TypeConcrete The concrete mix design numberCT1-4500DI
The truck number from where the sample was collected7 The batch plant ticket number from where the sample was collectedNot provided
Concrete batch plantUnknown The fabricator/manufacturer designation for the samplePlant
A detailed description of where the material sample was collectedChute Where the material sample would have been placed if not sampledBridge 22 Deck Pour 1
From Lot No.Not set Bag Lot No.Not set

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