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Sample Record for 2022-03-30-1

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

Project Information

Project ID: 214573 DEA: 073096U4 EFIS: 0719000091 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R0.0/R9.7
Work Description: PLACE CONCRETE PAVEMENT, BARRIER, HMA, DRAINAGE, AND ELECTRICAL.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM INTERSTATE 5 TO WHEATLAND AVENUE UNDERCROSSING
Contractor Name: FLATIRON WEST INC
Contractor Address: 15335 FAIRFIELD RANCH ROAD, CHINO HILLS, CA 91709
Resident Engineer: Ridwan Salman Structure Rep.: Adriana Pimienta

Sample Information

DIME Sample ID: 2022-03-30-1
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: Department Acceptance
Type of Material: Concrete
Sample Taken Date: 03/30/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/30/2022
The quantity of what the sample constitutes: 10
A brief description of the sample: Concrete
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-0648
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons - North Hollywood

Material Information

The concrete mix design number: SC425N49
The truck number from where the sample was collected: 1698
The batch plant ticket number from where the sample was collected: 101C6557213
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
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:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2022-03-30-1-1
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Verified Date: 03/30/2022
Date Tested: 03/30/2022
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
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Unit weight of the concrete 148.12 lb/ft^3
Volume of the concrete 9.431 yd^3
Cement content 447.461 lb/yd^3