Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994864 DEA: 050N74U4 EFIS: 0522000025
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-9.9/10.6
Work Description: SB 101 4D North San Ysidro to Olive Mill
Location Description: In Santa Barbara County in and near Santa Barbara from 0.1 mile south of San Ysidro Road Overcrossing to 0.1 north of Olive Mill Road Overcrossing
Contractor Name: Craig Flowers (Granite Construction Company)
Contractor Address: PO Box 6744, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Emiliano Berntsen
DIME Sample ID: 2025-08-18-120
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: 08/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2025
The quantity of what the sample constitutes: 1
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex
The concrete mix design number: 1629003
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31714211
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Structural Concrete
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2025-08-18-120-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 03/13/2026
Date Tested: 09/15/2025
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: Average compressive strength complies with the specified design strength.
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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5390 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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5
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Break Description of Cylinder 2 (if not 'cone')
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5
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