Sample Record

Owner Lab

  • CT METS QASI - Los Angeles Design Build Field Laboratory

DIME Sample ID 2022-11-17-58

Project Information

Project IdentifiersProject ID: 993559
DEA: 120R5104
EFIS: 1218000102
DIST-CO-RTE-PM12-ORA-5-36.1
Award Date05/04/2022
Closeout Date01/12/2023
Work DescriptionPLACE RHMA-G AND HIGH FRICTION SURFACE TREATMENT.
Location DescriptionORANGE COUNTY IN ANAHEIM AT KATELLA AVENUE UNDERCROSSING
QA Service Level1 (Verified on 03/21/2022)

Sample Information

Sample Taken Date11/17/2022 Sample Unique Key58
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testing11/29/2022
Sample typeQuality Assurance A brief description of the sampleResins and peroxides
The quantity of what the sample constitutes5 jars (2 large, 3 small) From where was the sample collectedJob Site
First name of sampler or witnessed byDanny, Waleed, Andrew Last name of sampler or witnessed byChung, Saleh, Ferng
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameACC Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeHigh Friction Surface Treatment Mgf. Lot Number(s)111722_112122
Batch Number1 Mix Number1
Resin Binder TypePolyester Used for OverlayYes
Used for InlayNo

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Test File Attachments