Sample Record
Owner Lab
- CT D12 - Huntington Beach Field Laboratory
DIME Sample ID 2023-06-06-66
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Project Information
| Project Identifiers | Project ID: 213749 DEA: 120C1104 EFIS: 1200000633 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-57-20.3/21.6 |
| Award Date | 04/19/2019 |
| Closeout Date | Not set |
| Work Description | SR-57 Lambert Interchange Project: WIDEN BRIDGES AND CONSTRUCT RW, SW, HMA, JPCP AND ELECTRICAL SYSTEMS. |
| Location Description | ORANGE COUNTY IN BREA FROM 0.6 MILE SOUTH TO 0.7 MILE NORTH OF LAMBERT ROAD UNDERCROSSING |
| QA Service Level | 1 (Verified on 05/31/2019) |
Sample Information
| Sample Taken Date | 06/06/2023 | Sample Unique Key | 66 |
|---|---|---|---|
| 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 | 06/06/2023 |
| Sample type | Quality Assurance | A brief description of the sample | 6x6x18 Beam |
| The quantity of what the sample constitutes | 4 | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | David | Last name of sampler or witnessed by | Nguyen |
| Title of sampler | Telephone number of sampler | 9492798470 | |
| Laboratory sample identification | 23-0181 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Security Paving | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Concrete | The concrete mix design number | 1605760 |
|---|---|---|---|
| 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 | Concrete from wheelbarrow | Where the material sample would have been placed if not sampled | LA5 5 plus 00 |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||