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Sample Record for 2020-02-20-15

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 213746 DEA: 080Q75U4 EFIS: 0817000114 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Work Description: REPLACEMENT OF TWO OUTSIDE LANES AND CONCRETE SLABS
Location Description:
Contractor Name: J McLoughlin Engineering
Contractor Address: 10641 Fulton Court, Rancho Cucamonga, CA 91730
Resident Engineer: Mujahid Qureshi Structure Rep.: Ching Chuang

Sample Information

DIME Sample ID: 2020-02-20-15
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 02/20/2020
Date that the sample was received by the laboratory/organization performing the testing: 02/21/2020
The quantity of what the sample constitutes: 2 Beams
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 1A1, 1A2
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RV Concrete Inc

Material Information

The concrete mix design number: G3-19-PCC-172
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: TT1
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: On Job Site at Concrete Truck
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2020-02-20-15-1
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Verified Date: 03/12/2020
Date Tested: 03/03/2020
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
What test method is being used? Third-Point Loading
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Modulus of rupture 700 psi

Test 2 of 2

DIME Test ID: 2020-02-20-15-2
Test Method: CTM 523-July 2012: Method of Test for Flexural Strength of Concrete
Verified Date: 03/12/2020
Date Tested: 03/03/2020
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
What test method is being used? Third-Point Loading
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Modulus of rupture 730 psi