Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215236 DEA: 081C6804 EFIS: 0812000343
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74,79and371-Varies
Work Description: REPLACE STRUCTURAL CONCRETE BRIDGE, RETAINING WALL AND BOX CULVERT.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: Ortiz Enterprise
Contractor Address: 6 Cushing, Suite 200, Irvine, Ca 92618-4221
Resident Engineer: Nick Truong Structure Rep.: Arnel L. Vega
DIME Sample ID: 2022-03-31-26
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/31/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/01/2022
The quantity of what the sample constitutes: 2 cylinders
A brief description of the sample: CIP Concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Temecula
The concrete mix design number: 1610974
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 30164745
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Location 3 - Arroyo Seco Stage 2
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-03-31-26-1
Test Method: CTM 521-June 2012: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 04/28/2022
Date Tested: 04/28/2022
Submitted By Organization: Sequoia Consultants
Organization Address: 361 West Grove Avenue,
Organization City: Orange
Organization State: CA
Organization Zipcode: 92865
Organization Email: sranjan@sequoiacon.com
Organization Phone: 1 (714) 974-6316
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of specimens
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2
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Average Compressive Strength (to nearest 10)
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5360 lb/in^2
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Cylinder Age
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28 days
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Break Description of Cylinder 1 (if not 'cone')
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no data
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Break Description of Cylinder 2 (if not 'cone')
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no data
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