Sample Record

Owner Lab

  • CT HQ - FFS - Skid Testing

DIME Sample ID 2024-02-23-3

Project Information

Project IdentifiersProject ID: 214579
DEA: 010B0904
EFIS: 0100020444
DIST-CO-RTE-PM01-DN-101-8.2/8.7
Award Date04/21/2020
Closeout DateNot set
Work DescriptionPanther Creek & Hunter Creek Bridges
Location DescriptionDEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
QA Service Level1 (Verified on 03/02/2020)

Sample Information

Sample Taken Date02/23/2024 Sample Unique Key3
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 testing02/23/2024
Sample typeAcceptance A brief description of the sampleBRIDGE DECK
The quantity of what the sample constitutesBRIDGE DECK From where was the sample collectedJob Site
First name of sampler or witnessed byHARISH Last name of sampler or witnessed byTHAKUR
Title of sampler Telephone number of sampler9152961873
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameJOB SITE 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 number0000000000000000
The truck number from where the sample was collected The batch plant ticket number from where the sample was collected00000000000000000
Concrete batch plant The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected00000000000000000 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