Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001996 DEA: 010P8704 EFIS: 0125000086
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-33/34.5
Work Description:
Location Description:
Contractor Name: FORD LOGGING DBA PACIFIC EARTHSCAPE
Contractor Address: 1225 Central Avenue # 11, McKinleyville, CA 95519
Resident Engineer: Cody Long Structure Rep.: Unknown
DIME Sample ID: 2026-04-28-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Boyd Road Field Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 04/28/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/29/2026
The quantity of what the sample constitutes: 38 CY
A brief description of the sample: Type II/V cement
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Eureka Ready mix
The concrete mix design number: ER70WH
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 2
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Discharge chute from back of truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-04-28-25-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 05/26/2026
Date Tested: 05/26/2026
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1050 River Ranch Road,
Organization City: Fortuna
Organization State: California
Organization Zipcode: 95540
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test: 3 @ 28 days
Test Result Compliance:
Additional Comments When Verified:
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Unit system used?
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US Units
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Number of specimens
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3
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Test performed
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With no density determined
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Capped in accordance with?
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ASTM C617 - Sulfur Mortar Cap
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Average diameter of cylinder 1
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4.00 in
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Average diameter of cylinder 2
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4.00 in
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Average diameter of cylinder 3
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4.00 in
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Cross sectional area of cylinder 1
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12.57 in^2
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Cross sectional area of cylinder 2
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12.57 in^2
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Cross sectional area of cylinder 3
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12.57 in^2
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Compressive strength (to nearest 10 psi)
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5010 psi
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Maximum load on cylinder 1
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5100 lb
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Maximum load on cylinder 2
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4900 lb
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Maximum load on cylinder 3
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5020 lb
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Type of fracture pattern of cylinder 1
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2
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Type of fracture pattern of cylinder 2
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2
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Type of fracture pattern of cylinder 3
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2
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Comment on any defect in either specimen or caps (Max 250 Characters)
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no data
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Correction factor for cylinder 1
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1
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Correction factor for cylinder 2
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1
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Correction factor for cylinder 3
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1
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Age of specimen
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28 days
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Age of specimen in hours
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no data0 hours
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