Sample Record

Owner Lab

  • CT D09 - Bishop Field Laboratory

DIME Sample ID 2023-06-19-14

Project Information

Project IdentifiersProject ID: 994363
DEA: 09391504
EFIS: 0922000013
MINOR: 09A0893
DIST-CO-RTE-PM09-INY,MNO,MNO,MNO,MNO-395,395,6,6-R18.08, 63.55, 21.14, 27.4
Award Date08/05/2022
Closeout Date01/02/2023
Work DescriptionDistrict CCTV and RWIS Replacements
QA Service Level1 (Verified on 10/26/2022)

Sample Information

Sample Taken Date06/19/2023 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 testing06/20/2023
Sample typeQuality Assurance A brief description of the sample4 PCC Cylinders
The quantity of what the sample constitutes2 yards From where was the sample collectedJob Site
First name of sampler or witnessed byJerid Last name of sampler or witnessed byKupelian
Title of samplerQA Material Tester Telephone number of sampler8058042482
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility name711 Materials Ridgecrest Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure namelocation 1

Material Information

Material TypeConcrete The concrete mix design number628211A
The truck number from where the sample was collected86026 The batch plant ticket number from where the sample was collected835741
Concrete batch plant711 Materials Ridgecrest The fabricator/manufacturer designation for the sampleconcrete plant
A detailed description of where the material sample was collectedCHUTE FROM TRUCK 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