Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993511 DEA: 120R2004 EFIS: 1218000065
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-0.0/2.0
Work Description: PLACE PRECAST CONCRETE PAVEMENT AND REPLACE CONCRETE SLAB.
Location Description: ORANGE COUNTY IN SAN CLEMENTE FROM ORANGE COUNTY LINE TO 0.4 MILE NORTH OF EL CAMINO REAL UNDERCROSSING
Contractor Name: Myers & Sons (SBE)
Contractor Address: 2554 Millcreek Drive, Sacramento, CA 95833
Resident Engineer: Mona Shahidi Structure Rep.: Unknown
DIME Sample ID: 2022-09-29-22
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 09/29/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2022
The quantity of what the sample constitutes: 3 concrete beams+1 extra
A brief description of the sample: RSC Flexural Beams
From where was the sample collected: Job Site
Laboratory sample identification: 22-0368
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GL THROOP
The concrete mix design number: 2010-007
The truck number from where the sample was collected: 112
The batch plant ticket number from where the sample was collected: 1
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: JPCP-RS beams poured at SB EL Camino Real Onramp at Mainline SB I-5
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2022-09-29-22-1
Test Method: CTM 524-March 2013: Method of Test for Flexural Strength Of Rapid Strength Concrete
Verified Date: 10/05/2022
Date Tested: 10/02/2022
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test: <<3 days break on Sun, Oct 2, 2022>>
Test Result Compliance: complies
Additional Comments When Verified:
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Number of specimens
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3
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Does the testing machine measure load or stress on the beam specimen?
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Load
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Fracture initiates in the tension surface
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Outside of the Middle Third of the Span Lengt
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Fracture occurred at a capped section
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No
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Is a beam dimensional correction factor used?
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No
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Age of specimen
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3 days
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