Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213746 DEA: 080Q75U4 EFIS: 0817000114
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD,RIV-60-R4.6/R9.9, R0.0/12.2
Work Description: REPLACEMENT OF TWO OUTSIDE LANES AND CONCRETE SLABS
Location Description:
Contractor Name: J McLoughlin Engineering
Contractor Address: 10641 Fulton Court, Rancho Cucamonga, CA 91730
Resident Engineer: Mujahid Qureshi Structure Rep.: Ching Chuang
DIME Sample ID: 2019-07-27-1
TL Number from the TL Form: 20190727
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: 07/27/2019
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2019
The quantity of what the sample constitutes: 2
A brief description of the sample: LCB RS Cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 999-727
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JMECI RV Concrete Inc
The concrete mix design number: CTS-30-RAM
The truck number from where the sample was collected: 7
The batch plant ticket number from where the sample was collected: NP
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Batch
A detailed description of where the material sample was collected: EB 60 lane 2 Valley Way
Where the material sample would have been placed if not sampled: EB 60 lane 2 Valley Way
From Lot No.: Unknown
Bag Lot No.: Unknown
DIME Test ID: 2019-07-27-1-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 08/05/2019
Date Tested: 08/03/2019
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: 9098293029
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of specimens
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6
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Average Compressive Strength (to nearest 10)
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1140 lb/in^2
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Cylinder Age
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7 days
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Break Description of Cylinder 1 (if not 'cone')
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1
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Break Description of Cylinder 2 (if not 'cone')
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1
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Break Description of Cylinder 3 (if not 'cone')
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1
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Break Description of Cylinder 4 (if not 'cone')
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4
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Break Description of Cylinder 5 (if not 'cone')
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4
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Break Description of Cylinder 6 (if not 'cone')
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1
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