Sample Record
Owner Lab
- CT D12 - Huntington Beach Field Laboratory
DIME Sample ID 2022-10-08-15
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Project Information
| Project Identifiers | Project ID: 993154 DEA: 120R3404 EFIS: 1218000079 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-73-12.9/R26.8 |
| Award Date | 09/16/2021 |
| Closeout Date | 09/28/2023 |
| Work Description | REPLACE APPROACH SLABS, JOINT SEAL, AND APPLY METHACRYLATE ON BRIDGES. |
| Location Description | ORANGE COUNTY AT VARIOUS LOCATIONS FROM MOULTON PARKWAY UNDERCROSSING IN LAGUNA NIGUEL TO BRISTOL STREET UNDERCROSSING IN COSTA MESA |
| QA Service Level | 1 (Verified on 08/02/2021) |
Sample Information
| Sample Taken Date | 10/08/2022 | Sample Unique Key | 15 |
|---|---|---|---|
| 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 testing | 10/10/2022 |
| Sample type | Quality Assurance | A brief description of the sample | 6x12 concrete cylinders |
| The quantity of what the sample constitutes | 6 concrete cylinders | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Paul | Last name of sampler or witnessed by | Pastora |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 22-0390 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Shortload Mobile Mixers | Transportation Laboratory (TL) Number | 265707 |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | CTS-72-EHI |
|---|---|---|---|
| The truck number from where the sample was collected | The batch plant ticket number from where the sample was collected | 1 | |
| Concrete batch plant | The fabricator/manufacturer designation for the sample | ||
| A detailed description of where the material sample was collected | RTE 73 Approach Slabs Br | Where the material sample would have been placed if not sampled | LOC 10 S73 Bristol St Uc Br |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
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|---|---|---|---|
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