Sample Record for 2021-03-06-7
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214029 DEA: 07301104 EFIS: 0714000009
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60,710-710-R2.8/11.8, 24.1/25.1
Work Description: Roadway ex, place jointed plain concrete pavement & concrete barrieres
Location Description: In Los Angeles County at avocado Heights on Route 60 from 0.5 Mile west of Route 60/710 Separation to Route 60/605 Separation AND on Route 710 from 0.5 miles south of Route 710/60 Separation to 0.5 mile north of Route 710/60 Separation.
Contractor Name: GUY F. ATKINSON CONSTRUCTION, LLC
Contractor Address: 18201 Von Karman Ave #800, Irvine, CA 92612
Resident Engineer: Sepand Minovi Structure Rep.: Rick Jensen
Sample Information
DIME Sample ID: 2021-03-06-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 03/06/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2021
The quantity of what the sample constitutes: 10 CY
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 21-0696
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertson Ready Mix
Material Information
The concrete mix design number: RRM19097
The truck number from where the sample was collected: Load 10
The batch plant ticket number from where the sample was collected: 5783583
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bobcat on site
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
Test 1 of 2
DIME Test ID: 2021-03-06-7-1
Test Method: CTM 521-June 2020: Method of Test for Compressive Strength of Molded Concrete Cylinders
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
Test 2 of 2
DIME Test ID: 2021-03-06-7-2
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
