Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2016-10-19-11

Project Information

Project IdentifiersProject ID: 208945
DEA: 07288604
EFIS: 0700021080
COOP: 074663
DIST-CO-RTE-PM07-LA-710-6.0-9.4
Award Date09/02/2011
Closeout DateNot set
Work DescriptionGerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location DescriptionPort of Long Beach (District 7)
QA Service Level1 (Verified on 06/03/2013)

Sample Information

Sample Taken Date10/19/2016 Sample Unique Key11
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 testing10/24/2016
Sample typeQuality Control A brief description of the sampleLightweight Concrete 3x6
The quantity of what the sample constitutes6 From where was the sample collectedJob Site
First name of sampler or witnessed byCardiel Last name of sampler or witnessed byBugarin
Title of samplerIQA Telephone number of samplerUnknown
Laboratory sample identification866-L4 Linked DIME Sample IDUnknown
The fabricator/manufacturer/facility nameSFI Transportation Laboratory (TL) Number101916RWNLCCL4
Inspector Lot Number from the Transportation Laboratory (TL) FormUnknown Structure unique identifierUnknown
Structure nameUnknown

Material Information

Material TypeConcrete The concrete mix design numberNA
The truck number from where the sample was collectedNA The batch plant ticket number from where the sample was collectedNA
Concrete batch plantNA The fabricator/manufacturer designation for the sampleNA
A detailed description of where the material sample was collectedMixed on Site Where the material sample would have been placed if not sampledRW N LCC LIFT 4
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

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Test File Attachments