Sample Record
Owner Lab
- CT D08 - Fontana Southern Regional Laboratory
DIME Sample ID 2023-10-27-41
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Project Information
| Project Identifiers | Project ID: 214336 DEA: 07302404 EFIS: 0713000488 |
|---|---|
| DIST-CO-RTE-PM | 07-VEN-101-37/40 |
| Award Date | 11/17/2020 |
| Closeout Date | 09/24/2024 |
| Work Description | PADRE JUAN REHAB |
| Location Description | VEN 101 |
| QA Service Level | 1 (Verified on 02/26/2021) |
Sample Information
| Sample Taken Date | 10/27/2023 | Sample Unique Key | 41 |
|---|---|---|---|
| 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 | 11/01/2023 |
| Sample type | Verification | A brief description of the sample | Scrap |
| The quantity of what the sample constitutes | 1 Qt. Of Scrap | From where was the sample collected | Manufacturer |
| First name of sampler or witnessed by | Victor | Last name of sampler or witnessed by | Pham |
| Title of sampler | Telephone number of sampler | ||
| Laboratory sample identification | 0560G-23 | Linked DIME Sample ID | |
| The fabricator/manufacturer/facility name | Granite Construction - Santa Paula | 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 | Scrap Tire |
|---|---|---|---|
| Crumb Rubber Modifier Mix Number | 1556 |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||