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Sample Record for 2023-03-29-15

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

Project Information

Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029 QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50-L0.2/R6.1
Work Description: Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC
Location Description: FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: John Ruzic Structure Rep.: Conor Hennessy

Sample Information

DIME Sample ID: 2023-03-29-15
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Rocklin Construction Field Office
Sample Organization Contact: 530-330-2727
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/29/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/17/2023
The quantity of what the sample constitutes: 1000 CY
A brief description of the sample: structural concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex

Material Information

The concrete mix design number: 1619232
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 30673616
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2023-03-29-15-1
Test Method: CTM 556-January 2018: Method of Test for Slump of Fresh Portland Cement Concrete
Verified Date: 11/18/2025
Date Tested: 03/29/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Slump 4.5 inch

Test 2 of 3

DIME Test ID: 2023-03-29-15-2
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 11/18/2025
Date Tested: 03/29/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Temperature 69 F

Test 3 of 3

DIME Test ID: 2023-03-29-15-3
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 11/18/2025
Date Tested: 04/26/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Unit system used? US Units
Number of specimens 2
Test performed With no density determined
Capped in accordance with? ASTM C617 - Sulfur Mortar Cap
Average diameter of cylinder 1 6.01 in
Average diameter of cylinder 2 6.01 in
Cross sectional area of cylinder 1 28.37 in^2
Cross sectional area of cylinder 2 28.3 in^2
Compressive strength (to nearest 10 psi) 4780 psi
Maximum load on cylinder 1 136150 lb
Maximum load on cylinder 2 135040 lb
Type of fracture pattern of cylinder 1 3
Type of fracture pattern of cylinder 2 3
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Correction factor for cylinder 2 1
Age of specimen 28 days
Age of specimen in hours no data0 hours