Sample Record

Owner Lab

  • CT D12 - Huntington Beach Field Laboratory

DIME Sample ID 2022-10-08-14

Project Information

Project IdentifiersProject ID: 993154
DEA: 120R3404
EFIS: 1218000079
DIST-CO-RTE-PM12-ORA-73-12.9/R26.8
Award Date09/16/2021
Closeout DateNot set
Work DescriptionREPLACE APPROACH SLABS, JOINT SEAL, AND APPLY METHACRYLATE ON BRIDGES.
Location DescriptionORANGE COUNTY AT VARIOUS LOCATIONS FROM MOULTON PARKWAY UNDERCROSSING IN LAGUNA NIGUEL TO BRISTOL STREET UNDERCROSSING IN COSTA MESA
QA Service Level1 (Verified on 08/02/2021)

Sample Information

Sample Taken Date10/08/2022 Sample Unique Key14
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 testing10/10/2022
Sample typeQuality Assurance A brief description of the sample6x12 concrete cylinders
The quantity of what the sample constitutes2 concrete cylinders From where was the sample collectedJob Site
First name of sampler or witnessed byPaul Last name of sampler or witnessed byPastora
Title of sampler Telephone number of sampler
Laboratory sample identification22-0390 Linked DIME Sample ID
The fabricator/manufacturer/facility nameShortload Mobile Mixers Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design numberCTS-72-EHI
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected1
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedRt. 73 Approach Slabs 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