Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994650 DEA: 070W4704 EFIS: 0722000073
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-33,101-Var
Work Description: PLACE PIPELINER, CLEAN, INSPECT AND PREPARE CULVERTS.
Location Description: VENTURA COUNTY AT VARIOUS LOCATIONS
Contractor Name: GBA ENGINEERING
Contractor Address: Unknown
Resident Engineer: Joseph Tehrani Structure Rep.: Unknown
DIME Sample ID: 2024-12-17-57
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 12/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/18/2024
The quantity of what the sample constitutes: 10CY
A brief description of the sample: Concrete Test Samples
From where was the sample collected: Job Site
Laboratory sample identification: 25-0004
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Associate Ready mixed Concrete
The concrete mix design number: SL705SC30
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 7248494
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Wheel Barrow from Chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-12-17-57-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 01/28/2025
Date Tested: 01/28/2025
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of specimens
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2
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Average Compressive Strength (to nearest 10)
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6760 lb/in^2
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Cylinder Age
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42 days
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Break Description of Cylinder 1 (if not 'cone')
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Type 5
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Break Description of Cylinder 2 (if not 'cone')
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Type 5
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