Sample Record

Owner Lab

  • CT D05 - Carpinteria Field Laboratory

DIME Sample ID 2023-11-22-19

Project Information

Project IdentifiersProject ID: 215753
DEA: 050N72U4
EFIS: 0520000169
DIST-CO-RTE-PM05-SB-101-4.4/R7.7
Award Date03/01/2021
Closeout DateNot set
Work DescriptionPlease cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description101 freeway in Summerland, CA
QA Service Level1 (Verified on 05/06/2021)

Sample Information

Sample Taken Date11/22/2023 Sample Unique Key19
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 testing11/22/2023
Sample typeQuality Assurance A brief description of the sample1x4 PCC Aggregates
The quantity of what the sample constitutes30 Cubic Yards From where was the sample collectedSupplier
First name of sampler or witnessed byEduardo Last name of sampler or witnessed byGomez
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameCEMEX Santa Barbara Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeConcrete The concrete mix design number1628224
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected3102578
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedDischarge from concrete truck into wheelbarrow. Where the material sample would have been placed if not sampled
From Lot No. Bag Lot No.

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Sample File Attachments

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Test File Attachments