Sample Record

Owner Lab

  • CT HQ - Sacramento Materials Management Branch Field Office

DIME Sample ID 2023-01-26-27

Project Information

Project IdentifiersProject ID: 99999
DEA: 0322222
DIST-CO-RTE-PM03-SAC,OMG-888,99,80-0.6-0.6
Award DateNot set
Closeout DateNot set
Work DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location DescriptionTHIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
QA Service Level (Verified on 04/05/2013)

Sample Information

Sample Taken Date01/26/2023 Sample Unique Key27
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 testing01/26/2023
Sample typeQuality Assurance A brief description of the samplestructural concrete
The quantity of what the sample constitutes200 cy From where was the sample collectedJob Site
First name of sampler or witnessed bybrett Last name of sampler or witnessed bysoldano
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameTeichert Matls Vernalis 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 number12345
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected2546
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedConcrete from wheelbarrow 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