Sample Record
Owner Lab
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2023-06-05-63
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Project Information
| Project Identifiers | Project ID: 993547 DEA: 081G7204 EFIS: 0816000057 COOP: 081666 Permit Numbers: 0819AOP0691 |
|---|---|
| DIST-CO-RTE-PM | 08--- |
| Award Date | 12/30/2021 |
| Closeout Date | Not set |
| Work Description | METS have reviewed the (Source Inspection Quality Management Plan) SIQMP, Rev1 submitted on behalf of The city of Lake Elsinore. We are glad to inform you that it significantly complies. |
| Location Description | Not set |
| QA Service Level | 2 (Verified on 01/31/2022) |
Sample Information
| Sample Taken Date | 06/05/2023 | Sample Unique Key | 63 |
|---|---|---|---|
| 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 | 07/21/2023 |
| Sample type | Verification | A brief description of the sample | Hi-Natural |
| The quantity of what the sample constitutes | 1 Bag Of Hi-Nat | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Victor | Last name of sampler or witnessed by | Capacete |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 0376G-23 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | All American Asphalt- Corona | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | Crumb Rubber Modifier | CRM Type | High Natural |
|---|---|---|---|
| Crumb Rubber Modifier Mix Number | 106836 |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2023-06-05-63-1 CTM 208-September 2011 (Verified)
DIME Test ID: 2023-06-05-63-2 CTM 385-November 2016 (Verified)