Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2016-08-30-12

Project Information

Project IdentifiersProject ID: 209950
DEA: 080N56U4
EFIS: 0813000176
DIST-CO-RTE-PM08-SBD-40-R94.7/R99.7
Award Date01/22/2015
Closeout Date09/17/2018
Work DescriptionBRIDGE REPLACEMENTS.
Location DescriptionSAN BERNARDINO COUNTY NEAR ESSEX AT HALLER WASH BRIDGE AT ROJO WASH BRIDGE AND AT CLIPPER VALLEY WASH BRIDGE
QA Service Level1 (Verified on 04/29/2015)

Sample Information

Sample Taken Date08/30/2016 Sample Unique Key12
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 testing09/06/2016
Sample typeQuality Assurance A brief description of the sample6x12
The quantity of what the sample constitutes2 From where was the sample collectedJob Site
First name of sampler or witnessed byROBERT Last name of sampler or witnessed byBERSBACH
Title of samplerASR Telephone number of samplerUnknown
Laboratory sample identification907-05C Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility namerobertsons Transportation Laboratory (TL) Number2016-05C
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierROJO WASH
Structure nameABUTMENT 1 FOOTING

Material Information

Material TypeConcrete The concrete mix design numberrrm15027
The truck number from where the sample was collected1194 The batch plant ticket number from where the sample was collected2212909
Concrete batch plantUnknown The fabricator/manufacturer designation for the sampleUnknown
A detailed description of where the material sample was collectedload 8 Where the material sample would have been placed if not sampledABUTMENT 1 FOOTING
From Lot No.Unknown Bag Lot No.Unknown

Submitted Tests

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

File NameExtensionDate UploadedActions
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Test File Attachments