Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2023-09-30-43
TL Number from the TL Form: 1
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: 09/30/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2023
The quantity of what the sample constitutes: 3
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 202309930 TEST 16C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Lane Security Joint Venture
The concrete mix design number: 1610887
The truck number from where the sample was collected: 10064186
The batch plant ticket number from where the sample was collected: 30948109
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SBCTA I0 CORRIDOR EB MAINLINE EULID OFF RAMP TO EULID ON RAM, STA 117300 TO 118700
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2023-09-30-43-1
Test Method: ASTM C293-10: Standard Test Method for Flexural Strength of Concrete (Using Simple Beam With Center-Point Loading)
Verified Date: 11/06/2023
Date Tested: 10/10/2023
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: 630 PSI OF AVERAGE 633 PSI FOR THREE BEAMS
Test Result Compliance: complies
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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900 psi
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