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Sample Record for 2022-05-21-13

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

Project Information

Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete

Sample Information

DIME Sample ID: 2022-05-21-13
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 05/21/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2022
The quantity of what the sample constitutes: 2
A brief description of the sample: cast concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: set 9J A B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LANEsecurity paving

Material Information

The concrete mix design number: G3-21-PRS-238
The truck number from where the sample was collected: NA
The batch plant ticket number from where the sample was collected: aT 1706PM LOAD 03
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: AT THE JOBSITE
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2022-05-21-13-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 06/03/2022
Date Tested: 05/31/2022
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
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
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 10 days
Modulus of rupture 550 psi

Test 2 of 2

DIME Test ID: 2022-05-21-13-2
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 06/03/2022
Date Tested: 05/31/2022
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
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
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 10 days
Modulus of rupture 480 psi