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Sample Record for 2025-06-25-57

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 1000612 DEA: 120R57U4 EFIS: 1223000131 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405-11.4/24.2
Work Description: PLACE JPCP (RSC) AND RHMA, AND MODIFY ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY FROM HARBOR BOULEVARD UNDERCROSSING IN COSTA MESA TO LOS ANGELES COUNTY LINE AT ROSSMOOR
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 9050 Norris Ave. #200, Westlake Village, CA 91361
Resident Engineer: Dennis Nguyen Structure Rep.: maribel Munoz Blanco

Sample Information

DIME Sample ID: 2025-06-25-57
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/25/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/25/2005
The quantity of what the sample constitutes: 2
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 25-0235
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: security paving

Material Information

The concrete mix design number: G3-25-CTS-389
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow.
Where the material sample would have been placed if not sampled: NB405 to WB22 connector
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2025-06-25-57-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 07/07/2025
Date Tested: 06/28/2025
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 3 days
Modulus of rupture 700 psi

Test 2 of 3

DIME Test ID: 2025-06-25-57-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 07/07/2025
Date Tested: 07/05/2025
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 10 days
Modulus of rupture 720 psi

Test 3 of 3

DIME Test ID: 2025-06-25-57-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 07/24/2025
Date Tested: 07/23/2025
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 28 days
Modulus of rupture 690 psi