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Sample Record for 2021-10-19-21

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

Project Information

Project ID: 215587 DEA: 081L6804 EFIS: 0820000138 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-7.5/13.4,8.2/23.9
Work Description: SLAB REPLACEMENT, PLACE SLURRY SEAL AND REPLACE AC SURFACING.
Location Description: RIVERSIDE COUNTY IN AND NEAR CORONA AND MURRIETA ON ROUTE 91 FROM ROUTE 15/91 SEPARATION TO 0.4 MILE EAST OF TYLER STREET AND ON ROUTE 15 FROM 1.5 MILES NORTH OF WINCHESTER ROAD TO NICHOLS ROAD
Contractor Name: RV Concrete
Contractor Address: 605 E Commercial Street, Anaheim, CA 92801
Resident Engineer: Denise Sostrom Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-10-19-21
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: 10/19/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2021
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: 5RA,5RB,5RC
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SHORTLOAD CONCRETE INC

Material Information

The concrete mix design number: CTS 65-EHI
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 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: 2021-10-19-21-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/26/2021
Date Tested: 10/22/2021
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 750 psi

Test 2 of 3

DIME Test ID: 2021-10-19-21-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/26/2021
Date Tested: 10/22/2021
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 3 of 3

DIME Test ID: 2021-10-19-21-3
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/26/2021
Date Tested: 10/22/2021
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 830 psi

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.