Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001169 DEA: 07314524 EFIS: 0722000300 COOP: 075283
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description: I-105 METRO Express Lanes Project
Location Description: LA-105 PM R0.6/R10.1, LA-110 PM R14.1/R16.6
Contractor Name: Flatiron-Myers (JV)
Contractor Address: Unknown
Resident Engineer: Roger Miramontes Structure Rep.: James Holloway
DIME Sample ID: 2026-04-03-41
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/03/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2026
The quantity of what the sample constitutes: 10 CY
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 040226-ID514-JPCP105EB-1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
The concrete mix design number: CT632CPA
The truck number from where the sample was collected: Truck 0
The batch plant ticket number from where the sample was collected: Load 6
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-04-03-41-1
Test Method: CTM 557-June 2020: Method of Test for Temperature of Freshly Mixed Hydraulic Cement Concrete
Verified Date: 04/09/2026
Date Tested: 04/03/2026
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance: not applicable
Additional Comments When Verified:
DIME Test ID: 2026-04-03-41-2
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 04/09/2026
Date Tested: 04/03/2026
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance: not applicable
Additional Comments When Verified:
DIME Test ID: 2026-04-03-41-3
Test Method: CTM 523-May 2020: Method of Test for Flexural Strength of Concrete
Verified Date: 04/09/2026
Date Tested: 04/08/2026
Submitted By Organization: Alta Vista Solutions - Whittier
Organization Address: 12409 Slauson Avenue, Suite I,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90606
Organization Email: nicholas.hoffmann@oneatlas.com
Organization Phone: (510) 542-9827
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of specimens
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3
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Unit system used?
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US Units
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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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Is a beam dimensional correction factor used?
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No
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Modulus of rupture average
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515 psi
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Modulus of rupture
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515 psi
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Modulus of rupture 2
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520 psi
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Modulus of rupture 3
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515 psi
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Age of specimen
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5 days
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