Sample Record

Owner Lab

  • CT HQ - FFS - Skid Testing

DIME Sample ID 2023-06-26-24

Project Information

Project IdentifiersProject ID: 214469
DEA: 030H08U4
EFIS: 0319000029
DIST-CO-RTE-PM03-SAC-50-L0.2/R6.1
Award Date06/30/2020
Closeout DateNot set
Work DescriptionSac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC
Location DescriptionFROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
QA Service Level1 (Verified on 10/23/2019)

Sample Information

Sample Taken Date06/26/2023 Sample Unique Key24
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 testing06/26/2023
Sample typeDepartment Acceptance A brief description of the samplePortable Skid Test
The quantity of what the sample constitutesSkid Testing From where was the sample collectedJob Site
First name of sampler or witnessed byJessie Last name of sampler or witnessed byWilson
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameJob Site Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeRoadway/Bridge Surface Pavement Surface TypeNot set
Type of Traffic Control ProvidedNot set DIST-CO-RTENot set
Direction of TravelNot set Post MileNot set
Lanes to be TestedNot set StationNot set

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