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Sample Record for 2021-02-06-5

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

Project Information

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

Sample Information

DIME Sample ID: 2021-02-06-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: (951) 840-8328
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 02/06/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/07/2021
The quantity of what the sample constitutes: 3 Beams
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 76J-1A,76J-1B,76J-1C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RV Concrete Inc

Material Information

The concrete mix design number: RVC-60-1
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: TT1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: concrete sample from wheel barrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:

Test Results

Test 1 of 3

DIME Test ID: 2021-02-06-5-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 02/17/2021
Date Tested: 02/17/2021
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria St.,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Modulus of rupture 780 psi

Test 2 of 3

DIME Test ID: 2021-02-06-5-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 02/17/2021
Date Tested: 02/17/2021
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria St.,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Modulus of rupture 790 psi

Test 3 of 3

DIME Test ID: 2021-02-06-5-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 02/17/2021
Date Tested: 02/17/2021
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria St.,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Modulus of rupture 710 psi