Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2024-04-08-24

Project Information

Project IdentifiersProject ID: 994147
DEA: 120R4104
EFIS: 1218000090
DIST-CO-RTE-PM12-ORA-1-17.4/21.5
Award Date09/27/2022
Closeout DateNot set
Work DescriptionCOLD PLANE AC AND PLACE RHMA-G.
Location DescriptionORANGE COUNTY IN NEWPORT BEACH FROM JAMBOREE ROAD TO SANTA ANA RIVER BRIDGE
QA Service Level1 (Verified on 06/28/2023)

Sample Information

Sample Taken Date04/08/2024 Sample Unique Key24
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 testing04/09/2024
Sample typeVerification A brief description of the sample3/4" RWHMA-G-SP 0.25% Evo
The quantity of what the sample constitutes4 Bags Combined, 1 Bag CRM, 1 Bag High Nat From where was the sample collectedSupplier
First name of sampler or witnessed byRJ Noble QC Last name of sampler or witnessed byOrange
Title of sampler Telephone number of sampler
Laboratory sample identification0165G-24 Linked DIME Sample ID
The fabricator/manufacturer/facility nameR.J. Noble - Orange Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeAggregate Source Identification (SMARA, name of Pit or Job Site)91-33-0027, 91-33-0014, 91-33-0027
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedBelt Cut at RJ Noble Orange Plant
Where the material sample would have been placed if not sampled Primary Aggregate Nominal Size3/4 inch
The concrete mix design number49R003ARSPWEO Lot number
Sublot number Aggregate Mix Number

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