Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002682 DEA: 112N2554 EFIS: 1125000084
QA Service Level: 1
DIST-CO-RTE-PM: 11-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: RV Concrete
Contractor Address: 605 E Commercial Street, Anaheim, CA 92801
Resident Engineer: Peris Salih Structure Rep.: Unknown
DIME Sample ID: 2026-10-08-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 10/08/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2026
The quantity of what the sample constitutes: Field Sample
A brief description of the sample: Field Sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Volumetric Truck
The concrete mix design number: CTS-65-EHI
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample: ISR RSC
A detailed description of where the material sample was collected: Field
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-10-08-2-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 10/12/2026
Date Tested: 10/12/2026
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
General Comments for this Test: 3 days - Complies. Tested 6110 psi avg. Min required is 4760 psi
Test Result Compliance: complies
Additional Comments When Verified:
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Number of specimens
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3
|
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Average Compressive Strength (to nearest 10)
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6110 lb/in^2
|
|
Cylinder Age
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3 days
|
|
Break Description of Cylinder 1 (if not 'cone')
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2
|
|
Break Description of Cylinder 2 (if not 'cone')
|
2
|
|
Break Description of Cylinder 3 (if not 'cone')
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2
|
