Sample Record
Owner Lab
- CT D01 - District 1 Materials Laboratory
DIME Sample ID 2023-08-14-44
Project Information
Project Identifiers | Project ID: 993715 DEA: 010G1404 EFIS: 0116000129 |
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DIST-CO-RTE-PM | 01-HUM-96,169-VAR |
Award Date | 11/16/2022 |
Closeout Date | Not set |
Work Description | HUM 96-169 5 Bridges Rail Upgrade (Do not include in project name: STRUCTURAL STEEL, CONCRETE BARRIER, POLYESTER CONCRETE OVERLAY) |
Location Description | HUMBOLDT COUNTY ON ROUTES 96 AND 169 AT VARIOUS LOCATIONS (Bridge Nos. 04-0215, 04-0059, 04-0063, 04-0225, 04-0061) |
QA Service Level | 1 (Verified on 04/19/2022) |
Sample Information
Sample Taken Date | 08/14/2023 | Sample Unique Key | 44 |
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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 | 08/15/2023 |
Sample type | Quality Assurance | A brief description of the sample | 3 4x8 cylinders |
The quantity of what the sample constitutes | unknown | From where was the sample collected | Job Site |
First name of sampler or witnessed by | Joe | Last name of sampler or witnessed by | Pedroni |
Title of sampler | ASR | Telephone number of sampler | 7075106120 |
Laboratory sample identification | Linked DIME Sample ID | ||
The fabricator/manufacturer/facility name | Mercer Fraser Company, Willow Creek Plant | Transportation Laboratory (TL) Number | |
Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | 12-04-0063 | |
Structure name | Bluff Creek Bridge |
Material Information
Material Type | Concrete | The concrete mix design number | MFCL1-45SLAGWC+SRA |
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The truck number from where the sample was collected | 682 | The batch plant ticket number from where the sample was collected | WC01557 |
Concrete batch plant | Willow Creek Mercer Fraser Plant | The fabricator/manufacturer designation for the sample | |
A detailed description of where the material sample was collected | CHUTE FROM TRUCK | Where the material sample would have been placed if not sampled | Approach Slab LF |
From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |
Test File Attachments
DIME Test ID: 2023-08-14-44-1 CTM 521-June 2020 (Verified)