Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214341 DEA: 081J2004 EFIS: 0817000237
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R21.5/R22.0
Work Description: EXTEND DECELARATION LANE
Location Description: SAN BERNARDINO COUNTY NEAR HESPERIA FROM 0.1 MILE NORTH OF ROUTE 15/138 SEPARATION TO GISH OVERHEAD
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Shaun Loza Structure Rep.: Ravinder Singh
DIME Sample ID: 2023-03-07-28
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: 03/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/08/2023
The quantity of what the sample constitutes: 1
A brief description of the sample: pcc beams rsc
From where was the sample collected: Job Site
Laboratory sample identification: 5B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sully Miller
The concrete mix design number: RRM122121
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: LOAD 4 AT 1008AM
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.:
DIME Test ID: 2023-03-07-28-1
Test Method: ASTM C293-10: Standard Test Method for Flexural Strength of Concrete (Using Simple Beam With Center-Point Loading)
Verified Date: 03/22/2023
Date Tested: 03/17/2023
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: 570PSI@28 DAYS BREAK
Test Result Compliance: does not comply
Additional Comments When Verified:
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Unit system used?
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US Units
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Modulus of rupture
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540 psi
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