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: 2022-12-16-33
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 12/16/2022
Date that the sample was received by the laboratory/organization performing the testing: 12/17/2022
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: structural concrete
From where was the sample collected: Fabricator
Laboratory sample identification:
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: 1822892
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Belt cut
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-12-16-33-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 01/23/2023
Date Tested: 01/13/2023
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of specimens
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2
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Average Compressive Strength (to nearest 10)
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4830 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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no data
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Break Description of Cylinder 2 (if not 'cone')
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no data
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