Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993815 DEA: 081C0814 EFIS: 0816000086 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R60.7/R74.3
Work Description: I-10 PAVEMENT REHABILITATION (SEGMENT 1) PROJECT
Location Description: Coachella
Contractor Name: COFFMAN SPECIALTIES, INC
Contractor Address: 4375 JUTLAND DRIVE STE 260, SAN DIEGO CA 92117
Resident Engineer: Michael Sergah Structure Rep.: Al Alina
DIME Sample ID: 2025-07-17-154
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 07/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/18/2025
The quantity of what the sample constitutes: 1 per batch
A brief description of the sample: CIP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hi Grade
The concrete mix design number: CT590F25
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 14021125
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: ID#90 (DS #37) Footing and DS #2 Invert - PR 281
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-07-17-154-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 11/24/2025
Date Tested: 08/14/2025
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
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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4330 lb/in^2
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Cylinder Age
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28 days
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Break Description of Cylinder 1 (if not 'cone')
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3
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Break Description of Cylinder 2 (if not 'cone')
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3
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