Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215365 DEA: 120Q9704 EFIS: 1218000010
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405-0/11.4
Work Description: I-405 improvement project from I-5 to Harbor Boulevard including extend pavement life, improve safety, enhance traffic operation, and incorporate Intelligent Transportation Systems (ITS).
Location Description: Orange County I-405 PM 0 - 11.4
Contractor Name: Guy F. Atkinson
Contractor Address: 38 Executive Park, IRVINE CA 92614
Resident Engineer: Mona Shahidi Structure Rep.: Brian Vo
DIME Sample ID: 2025-05-01-115
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: 05/01/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/02/2025
The quantity of what the sample constitutes: 1 per batch
A brief description of the sample: CIP Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Holiday Rock
The concrete mix design number: 3F36L005
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1567623
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Sand Canyon NB on ramp Type 30 Camera Foundation
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-05-01-115-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 02/22/2026
Date Tested: 05/29/2025
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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3680 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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