Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000286 DEA: 070W7004 EFIS: 0723000032
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-44.7/48.64
Work Description: INDIVIDUAL SLAB REPLACEMENT (RSC), & GRIND EXIST CONC PAVEMENT.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM NORDHOFF STREET UNDERCROSSING TO ROUTE 5/405 SEPARATION
Contractor Name: Interstate Civil Construction
Contractor Address: PO Box 2819, Wrightwood, CA 92397
Resident Engineer: ALI MOHSENZADEH Structure Rep.: Unknown
DIME Sample ID: 2024-11-15-76
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: 11/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2024
The quantity of what the sample constitutes: 200 cu. yd.
A brief description of the sample: ISR-RSC
From where was the sample collected: Job Site
Laboratory sample identification: 24-3506
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ICC
The concrete mix design number: CTS-65-EHI
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: From volumetric concrete mixer truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2024-11-15-76-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 06/26/2025
Date Tested: 11/18/2024
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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3
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Does the testing machine measure load or stress on the beam specimen?
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Load
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Fracture initiates in the tension surface
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Within the Middle Third of the Span Length
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Fracture occurred at a capped section
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No
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Is a beam dimensional correction factor used?
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No
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Age of specimen
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3 days
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Modulus of rupture
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980 psi
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Modulus of rupture 2
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890 psi
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Modulus of rupture average
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910 psi
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Modulus of rupture 3
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860 psi
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