Sample Record
Owner Lab
- CT D12 - Huntington Beach Field Laboratory
DIME Sample ID 2023-08-14-83
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Project Information
| Project Identifiers | Project ID: 994497 DEA: 120T5404 EFIS: 1222000062 MINOR: 12A2038 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-22,57-L9.7/11 |
| Award Date | 01/10/2023 |
| Closeout Date | Not set |
| Work Description | REPLACE EXISTING SIGN STRUCTURE, INSTALL CHEVRON SIGNS, REFRESH STRIPING |
| Location Description | ORANGE COUNTY ON 22 AND 57 |
| QA Service Level | 1 (Verified on 05/09/2023) |
Sample Information
| Sample Taken Date | 08/14/2023 | Sample Unique Key | 83 |
|---|---|---|---|
| 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 | 6x12 concrete cylinders |
| 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 | 23-0250 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Robertsons - Anaheim | 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 | SC590B33 |
|---|---|---|---|
| The truck number from where the sample was collected | The batch plant ticket number from where the sample was collected | 7885768 | |
| 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 | |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
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|---|---|---|---|
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