Sample Record
Owner Lab
- CT D06 - Millbrook Field Laboratory
DIME Sample ID 2024-06-04-24
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Project Information
| Project Identifiers | Project ID: 995260 DEA: 061G0504 EFIS: 0623000195 |
|---|---|
| DIST-CO-RTE-PM | 06-FRE-VAR,(180),245-99/104, (99.0)/0.0/(104.0)/9.0 |
| Award Date | 03/29/2023 |
| Closeout Date | Not set |
| Work Description | Routes 180, 245 Emergency Slip Out Repair |
| Location Description | Not set |
| QA Service Level | 1 (Verified on 10/20/2023) |
Sample Information
| Sample Taken Date | 06/04/2024 | Sample Unique Key | 24 |
|---|---|---|---|
| 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 testing | 06/05/2024 |
| Sample type | Verification | A brief description of the sample | PCC cylinders |
| The quantity of what the sample constitutes | 55 | From where was the sample collected | Job Site |
| First name of sampler or witnessed by | Sok | Last name of sampler or witnessed by | Thun |
| Title of sampler | ASR | Telephone number of sampler | 559 240 2128 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Outback Materials, Fresno | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | 06-1G0504 | |
| Structure name | Concrete Barrier Slab |
Material Information
| Material Type | Concrete | The concrete mix design number | 72T1X39 |
|---|---|---|---|
| The truck number from where the sample was collected | 113 | The batch plant ticket number from where the sample was collected | 160996 |
| Concrete batch plant | Outback Materials | The fabricator/manufacturer designation for the sample | |
| A detailed description of where the material sample was collected | Concrete from wheelbarrow | Where the material sample would have been placed if not sampled | Concrete Barrier Slab at Wall 2 |
| From Lot No. | Bag Lot No. |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2024-06-04-24-1 CTM 521-June 2020 (Verified)