Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994966 DEA: 073255U4 EFIS: 0722000129
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-20.2/26
Work Description: INDIVIDUAL SLAB REPLACEMENT, COLD PLANE AC
Location Description: LOS ANGELES COUNTY IN BALDWIN PARK AND IRWINDALE FROM ROUTE 10/605 SEPARATION TO 0.2 MILE NORTH OF ROUTE 210/605 SEPARATION
Contractor Name: Peterson Chase General Engineering
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Steven Taing Structure Rep.: Unknown
DIME Sample ID: 2025-08-23-7
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: 08/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/23/2025
The quantity of what the sample constitutes: 190 CY
A brief description of the sample: 3- 6X6X21 Rapid Set Concrete Beams
From where was the sample collected: Job Site
Laboratory sample identification: 25-2807
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SLC
The concrete mix design number: CTS-65 EHI
The truck number from where the sample was collected: 10
The batch plant ticket number from where the sample was collected: 0
Concrete batch plant:
The fabricator/manufacturer designation for the sample: SLC
A detailed description of where the material sample was collected: Chute discharge into wheel barrow
Where the material sample would have been placed if not sampled: NB605 near Ramona
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-08-23-7-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 08/26/2025
Date Tested: 08/26/2025
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: complies
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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820 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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850 psi
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Modulus of rupture 3
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840 psi
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