Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215212 DEA: 081F1434 EFIS: 0815000233
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-38.2/51.5
Work Description: INDIVIDUAL SLAB REPLACEMENT, REPLACE BASE & GRIND CONCRETE PAVEMENT.
Location Description: RIVERSIDE COUNTY IN CORONA AND EASTVALE FROM 0.5 MILE SOUTH OF ONTARIO AVENUE UNDERCROSSING TO ROUTE 60/15 SEPARATION
Contractor Name: Myers & Sons Construction
Contractor Address: 4600 Northgate Boulevard, Suite 100, Sacramento, CA 95834-1121
Resident Engineer: Ali Chinichian Structure Rep.: Unknown
DIME Sample ID: 2021-05-25-16
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/25/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/26/2021
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: 18RA,18RB,18RC
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Myers and Sons Construction
The concrete mix design number: 800-3RSC
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: TT
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: concrete sample from wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2021-05-25-16-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
DIME Test ID: 2021-05-25-16-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
DIME Test ID: 2021-05-25-16-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
