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Sample Record for 2021-03-01-33

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

Project Information

Project ID: 213707 DEA: 081C38U4 EFIS: 0817000196 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-6.7/R25.1
Work Description: Remove concrete pavement and base, and place HMA and JPCP
Location Description: ROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Elvira Lenart Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-03-01-33
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: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/01/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/02/2021
The quantity of what the sample constitutes: 3 beams
A brief description of the sample: PCC Rapid set beams
From where was the sample collected: Job Site
Laboratory sample identification: 13RA,13RB,13RC
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coffman

Material Information

The concrete mix design number: 1906-33
The truck number from where the sample was collected: Unknown
The batch plant ticket number from where the sample was collected: tt
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Discharge from concrete truck into wheelbarrow
Where the material sample would have been placed if not sampled: Unknown
From Lot No.: Unknown
Bag Lot No.: Unknown

Test Results

Test 1 of 3

DIME Test ID: 2021-03-01-33-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/11/2021
Date Tested: 03/11/2021
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 920 psi

Test 2 of 3

DIME Test ID: 2021-03-01-33-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/11/2021
Date Tested: 03/11/2021
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 950 psi

Test 3 of 3

DIME Test ID: 2021-03-01-33-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 03/11/2021
Date Tested: 03/11/2021
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 990 psi