Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001464 DEA: 072XU404 EFIS: 0725000290
QA Service Level: 1
DIST-CO-RTE-PM: 07--101-36.2
Work Description: Replace damaged slabs with ISR-RSC
Location Description:
Contractor Name: William Emerson
Contractor Address: Unknown
Resident Engineer: Alfred Ira Structure Rep.: Unknown
DIME Sample ID: 2026-01-09-40
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: 01/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/09/2026
The quantity of what the sample constitutes: 130 CY
A brief description of the sample: 6x6x18 Beams
From where was the sample collected: Job Site
Laboratory sample identification: 26-0076
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Troop
The concrete mix design number: NA
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: NA
Concrete batch plant: TROOP
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: truck chute
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-01-09-40-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 01/20/2026
Date Tested: 01/12/2026
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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780 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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830 psi
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Modulus of rupture 3
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820 psi
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