Sample Record

Owner Lab

  • CT D06 - Fresno Construction Field Office

DIME Sample ID 2024-04-23-42

Project Information

Project IdentifiersProject ID: 995260
DEA: 061G0504
EFIS: 0623000195
DIST-CO-RTE-PM06-FRE-VAR,(180),245-99/104, (99.0)/0.0/(104.0)/9.0
Award Date03/29/2023
Closeout DateNot set
Work DescriptionRoutes 180, 245 Emergency Slip Out Repair
Location DescriptionNot set
QA Service Level1 (Verified on 10/20/2023)

Sample Information

Sample Taken Date04/23/2024 Sample Unique Key42
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 testing04/25/2024
Sample typeQuality Assurance A brief description of the samplePile 10&12
The quantity of what the sample constitutes12 From where was the sample collectedJob Site
First name of sampler or witnessed byYe Last name of sampler or witnessed byYang
Title of samplerASR Telephone number of sampler5597790446
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameOutback Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name245 EMERGENCY WALL 2

Material Information

Material TypeConcrete The concrete mix design number40F5G07
The truck number from where the sample was collected110 The batch plant ticket number from where the sample was collected158308
Concrete batch plantOutback Materials The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collectedwheelbarrow Where the material sample would have been placed if not sampledPile 10&12
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