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Sample Record for 2015-04-23-3

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

Project Information

Project ID: 209217 DEA: 080F5404 EFIS: 0800000136 COOP: 081468 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-0.0/13.04, 35.64/45.14
Work Description: SR-91 Corridor Improvement Project: Develop approx. 8 miles of tolled express lanes and related improvements within SR 91 between the Riverside/Orange County line and I-15, including transition areas.
Location Description: 08-RIV-91-0.0/13.04; 12-ORA-91-R14.43/R18.91; 08-RIV-15-35.64/45.14
Contractor Name: Atkinson Walsh, Joint Venture
Contractor Address: 1785 Sampson Ave, Corona, CA 92879
Resident Engineer: Richard Hebert Structure Rep.: Cyrus Shahinpar

Sample Information

DIME Sample ID: 2015-04-23-3
TL Number from the TL Form: SRL 43
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Concrete
Sample Taken Date: 04/23/2015
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2015
The quantity of what the sample constitutes: 7
A brief description of the sample: 6X12
From where was the sample collected: Job Site
Laboratory sample identification: 888-SRL43
Structure unique identifier: Unknown
Structure name: BR 28 ABUT 5
The fabricator/manufacturer/facility name: Collected at jobsite

Material Information

The concrete mix design number: CM4261
The truck number from where the sample was collected: 286
The batch plant ticket number from where the sample was collected: 118022984
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: from mix truck
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: 2015-04-23-3-1
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 05/21/2015
Date Tested: 04/24/2015
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Cross sectional area of cylinder 1 27.99 in^2
Cross sectional area of cylinder 2 27.99 in^2
Cross sectional area of cylinder 3 27.99 in^2
Cross sectional area of cylinder 4 27.99 in^2
Cross sectional area of cylinder 5 27.99 in^2
Compressive strength (to nearest 10 psi) 4590 psi
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Age of specimen 1 days

Test 2 of 2

DIME Test ID: 2015-04-23-3-2
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 05/21/2015
Date Tested: 05/21/2015
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Cross sectional area of cylinder 1 27.99 in^2
Cross sectional area of cylinder 2 27.99 in^2
Compressive strength (to nearest 10 psi) 6650 psi
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Age of specimen 28 days