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Sample Record for 2021-12-21-4

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

Project Information

Project ID: 214524 DEA: 07304504 EFIS: 0714000067 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-57-R0.0/R4.5
Work Description: CONCRETE PAVEMENT, CONCRETE BARRIER, AND ELECTRICAL WORK.
Location Description: LOS ANGELES COUNTY IN DIAMOND BAR AND CITY OF INDUSTRY FROM ORANGE COUNTY LINE TO ROUTE 57/60 SEPARATION
Contractor Name: Griffith Company
Contractor Address: 3050 E. Birch Street, Brea, CA 92821
Resident Engineer: Martin Sandoval Structure Rep.: Avtar Bains

Sample Information

DIME Sample ID: 2021-12-21-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 12/21/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/22/2021
The quantity of what the sample constitutes: 310 cu. yd.
A brief description of the sample: Concrete
From where was the sample collected: Job Site
Laboratory sample identification: 21-3011
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vanguard at the 57 Freeway

Material Information

The concrete mix design number: 57030SL
The truck number from where the sample was collected: TM Load 1
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant: Vanguard BP at 57 FWY
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: BP Vanguard at loader bucket
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-12-21-4-1
Test Method: CTM 523-May 2020: Method of Test for Flexural Strength of Concrete
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
Data has not been verified.

Test 2 of 2

DIME Test ID: 2021-12-21-4-2
Test Method: CTM 523-May 2020: Method of Test for Flexural Strength of Concrete
Verified Date: 01/19/2022
Date Tested: 01/18/2022
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Number of specimens 2
Unit system used? US Units
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
Is a beam dimensional correction factor used? No
Modulus of rupture average 790 psi
Modulus of rupture 780 psi
Modulus of rupture 2 790 psi
Age of specimen 28 days