Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212246 DEA: 053307A4 EFIS: 0514000027
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-49.7/54.6
Work Description: Cholame Segment
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Andrew Borrelli Structure Rep.: Dave Lewis
DIME Sample ID: 2022-11-09-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Sample Organization Contact: 805-540-9933
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/09/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/10/2022
The quantity of what the sample constitutes: 3 concrete cylinders
A brief description of the sample: D.S. #24 Inlet 28 day
From where was the sample collected: Job Site
Laboratory sample identification: CTM521221109
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cal Portland Paso Robles
The concrete mix design number: 710RN2010
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: Unknown
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: MIDDLE OF THE LOAD
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-11-09-2-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 11/10/2022
Date Tested: 11/09/2022
Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Organization Address: 102 South Whitley Gardens Drive,
Organization City: Paso Robles
Organization State: CA
Organization Zipcode: 93346
Organization Email: kyle.engen@dot.ca.gov
Organization Phone: (805) 540-9933
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
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Number of specimens
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3
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Average Compressive Strength (to nearest 10)
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5280 lb/in^2
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Cylinder Age
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28 days
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Break Description of Cylinder 1 (if not 'cone')
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Cone
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Break Description of Cylinder 2 (if not 'cone')
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Cone
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Break Description of Cylinder 3 (if not 'cone')
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Cone
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