Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208900 DEA: 07265904 EFIS: 0700000497
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-1.6/10.4
Work Description: REPLACE BRIDGE RAILING.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AT VARIOUS LOCATIONS FROM FOUR LEVEL STRUCTURE TO LANKERSHIM BOULEVARD UNDERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 1792 KAISER AVE, IRVINE, CA 92614
Resident Engineer: HASSAN AZIMA Structure Rep.: Sarah Hartz
DIME Sample ID: 2015-03-19-3
TL Number from the TL Form: 150319
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 03/19/2015
Date that the sample was received by the laboratory/organization performing the testing: 03/23/2015
The quantity of what the sample constitutes: 8 CYLINDERS
A brief description of the sample: 6x12 concrete cylinders
From where was the sample collected: Job Site
Laboratory sample identification: 885-19
Structure unique identifier: Unknown
Structure name: CAHUENGA BRIDGE
The fabricator/manufacturer/facility name: Collected at jobsite
The concrete mix design number: 557237
The truck number from where the sample was collected: NOT PROVIDED
The batch plant ticket number from where the sample was collected: NOT PROVIDED
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: RIGHT SIDE CURB
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2015-03-19-3-2
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 03/30/2015
Date Tested: 03/30/2015
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Cross sectional area of cylinder 1
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28.27 in^2
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Cross sectional area of cylinder 2
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28.27 in^2
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Compressive strength (to nearest 10 psi)
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3900 psi
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Comment on any defect in either specimen or caps (Max 250 Characters)
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no data
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Correction factor for cylinder 1
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1
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Age of specimen
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11 days
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