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Sample Record for 2015-06-30-1

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

Project Information

Project ID: 7613 DEA: 071218W4 EFIS: 0700021119 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Gon Choi

Sample Information

DIME Sample ID: 2015-06-30-1
TL Number from the TL Form: 150630A
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 06/30/2015
Date that the sample was received by the laboratory/organization performing the testing: 07/02/2015
The quantity of what the sample constitutes: 6
A brief description of the sample: Concrete Cylinder 6 x 12
From where was the sample collected: Job Site
Laboratory sample identification: 889-30
Structure unique identifier: Unknown
Structure name: Stough Canyon Culvert Cover
The fabricator/manufacturer/facility name: National Ready Mix Concrete Company

Material Information

The concrete mix design number: S72017
The truck number from where the sample was collected: 438
The batch plant ticket number from where the sample was collected: 181762
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Plant
A detailed description of where the material sample was collected: Chute
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2015-06-30-1-1
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 07/07/2015
Date Tested: 07/07/2015
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 28.09 in^2
Cross sectional area of cylinder 2 28.09 in^2
Compressive strength (to nearest 10 psi) 2860 psi
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Age of specimen 7 days

Test 2 of 3

DIME Test ID: 2015-06-30-1-2
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 07/14/2015
Date Tested: 07/14/2015
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 28.09 in^2
Cross sectional area of cylinder 2 28.09 in^2
Compressive strength (to nearest 10 psi) 3740 psi
Comment on any defect in either specimen or caps (Max 250 Characters) no data
Correction factor for cylinder 1 1
Age of specimen 14 days

Test 3 of 3

DIME Test ID: 2015-06-30-1-3
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 07/28/2015
Date Tested: 07/28/2015
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 28.09 in^2
Cross sectional area of cylinder 2 28.09 in^2
Compressive strength (to nearest 10 psi) 4440 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