Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2023-02-06-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 02/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/06/2023
The quantity of what the sample constitutes: Two 4x8 concrete cylinders
A brief description of the sample: Concrete Samples
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex
The concrete mix design number: 1234
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 7597
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: concrete form wheelbarrow
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-02-06-5-1
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Verified Date: 02/06/2023
Date Tested: 02/06/2023
Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Organization Address: 1234 Norwalk Boulevard,
Organization City: Bellflower
Organization State: CA
Organization Zipcode: 90725
Organization Email: test.user@dot.ca.gov
Organization Phone: (213) 555-1212
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
|
Unit weight of the concrete
|
148.2 lb/ft^3
|
|
Cement content
|
615.3 lb/yd^3
|
DIME Test ID: 2023-02-06-5-2
Test Method: ASTM C143-20: Standard Test Method for Slump of Hydraulic-Cement Concrete
Verified Date: 02/06/2023
Date Tested: 02/06/2023
Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Organization Address: 1234 Norwalk Boulevard,
Organization City: Bellflower
Organization State: CA
Organization Zipcode: 90725
Organization Email: test.user@dot.ca.gov
Organization Phone: (213) 555-1212
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
DIME Test ID: 2023-02-06-5-3
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 02/06/2023
Date Tested: 02/06/2023
Submitted By Organization: ZZCT DIME Development Laboratory A - Bellflower - Internal
Organization Address: 1234 Norwalk Boulevard,
Organization City: Bellflower
Organization State: CA
Organization Zipcode: 90725
Organization Email: test.user@dot.ca.gov
Organization Phone: (213) 555-1212
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
