Sample Record
Owner Lab
- CT D12 - Huntington Beach Field Laboratory
DIME Sample ID 2023-10-06-51
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Project Information
| Project Identifiers | Project ID: 993870 DEA: 120R5604 EFIS: 1218000117 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-5,55,73,91,133,405-var |
| Award Date | 04/12/2023 |
| Closeout Date | Not set |
| Work Description | PLACE RHMA-G, HMA, SLAB REPLACEMENT AND JPCP. |
| Location Description | ORANGE COUNTY AT VARIOUS LOCATIONS |
| QA Service Level | 1 (Verified on 06/14/2022) |
Sample Information
| Sample Taken Date | 10/06/2023 | Sample Unique Key | 51 |
|---|---|---|---|
| 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 | 10/06/2023 |
| Sample type | Quality Assurance | A brief description of the sample | PCC Rapid set beams |
| The quantity of what the sample constitutes | 6 | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | G3 | Last name of sampler or witnessed by | G3 |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 23-0298 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Security Paving - Volumetric | 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 | G3-21-CTS-220 |
|---|---|---|---|
| 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 | Location 12 at SB73 Connector to SB55 |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
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