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Sample Record for 2021-10-07-15

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

Project Information

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

Sample Information

DIME Sample ID: 2021-10-07-15
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: 10/07/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2021
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: 77RA,77RB,77RC
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Myers and Sons Construction

Material Information

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: TTI
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: On Job Site at Concrete Truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 3

Test Results

Test 1 of 3

DIME Test ID: 2021-10-07-15-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/12/2021
Date Tested: 10/10/2021
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
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 3 days
Modulus of rupture 740 psi

Test 2 of 3

DIME Test ID: 2021-10-07-15-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/12/2021
Date Tested: 10/10/2021
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
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 3 days
Modulus of rupture 740 psi

Test 3 of 3

DIME Test ID: 2021-10-07-15-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/12/2021
Date Tested: 10/10/2021
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
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 1
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Fracture occurred at a capped section No
Is a beam dimensional correction factor used? No
Age of specimen 3 days
Modulus of rupture 650 psi