Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994405 DEA: 080F5414 EFIS: 0800000137 COOP: 081743
QA Service Level: 2
DIST-CO-RTE-PM: 08-RIV--
Work Description: RIV 71/91 FLYOVER
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Mohsen Javaherneshan Structure Rep.: Anton Schmieder
DIME Sample ID: 2023-11-27-52
TL Number from the TL Form:
Sample Submitted By Organization: Surecast West
Sample Organization Contact: (951) 491-9506
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 11/27/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/11/2023
The quantity of what the sample constitutes: 10.50
A brief description of the sample: TYPE II / V
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX-REDLANDS
The concrete mix design number: 1610974
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 31027262
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SAMPLE FROM WHEELBARROW
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-11-27-52-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 01/25/2024
Date Tested: 12/11/2023
Submitted By Organization: Surecast West
Organization Address: 8203 Alabama Street,
Organization City: Redlands
Organization State: CA
Organization Zipcode: 92373
Organization Email: cody@surecastwest.com
Organization Phone: (951) 491-9506
General Comments for this Test:
Test Result Compliance:
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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6000 lb/in^2
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Cylinder Age
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15 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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Break Description of Cylinder 3 (if not 'cone')
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no data
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