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Sample Record for 2021-03-14-2

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: 2021-03-14-2
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: 03/14/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/15/2021
The quantity of what the sample constitutes: 3 Beams
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 81J-4A,81J-4B,81J-4C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RV Concrete Inc

Material Information

The concrete mix design number: RVC-60-1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: TT1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: concrete sample from wheel barrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2021-03-14-2-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/25/2021
Date Tested: 03/24/2021
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:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 10 days
Modulus of rupture 750 psi

Test 2 of 3

DIME Test ID: 2021-03-14-2-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/25/2021
Date Tested: 03/24/2021
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:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 10 days
Modulus of rupture 730 psi

Test 3 of 3

DIME Test ID: 2021-03-14-2-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/25/2021
Date Tested: 03/24/2021
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:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 10 days
Modulus of rupture 750 psi