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Sample Record for 2023-10-03-103

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 993608 DEA: 081H8204 EFIS: 0817000138 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15,138-R21.6,R14.8/R15.1
Work Description: SIGNAL AND LIGHTING SYSTEM, HMA, JPCP, AND ROADWAY EXCAVATION.
Location Description: SAN BERNARDINO COUNTY IN PHELAN ON ROUTE 138 FROM 0.3 MILE WEST OF ROUTE 138/15 SEPARATION TO ROUTE 138/15 SEPARATION AND ON ROUTE 15 SOUTHBOUND EXIT RAMP AT ROUTE 138
Contractor Name: EVERLEVEL HOLDINGS, LLC
Contractor Address: 5877 PINE AVE. SUITE 240, CHINO HILLS, CA 91709
Resident Engineer: Vu Thanh Nguyen Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2023-10-03-103
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Acceptance
Type of Material: Concrete
Sample Taken Date: 10/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/04/2023
The quantity of what the sample constitutes: 2 Beams
A brief description of the sample: Concrete beams
From where was the sample collected: Job Site
Laboratory sample identification: 2H-A1, 2H-A2
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertson's Ready Mix - Adelanto

Material Information

The concrete mix design number: RRM22127
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 7951770
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: back of concrete truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test results on following page(s): 4

Test Results

Test 1 of 4

DIME Test ID: 2023-10-03-103-1
Test Method: CTM 504-June 2010: Method of Test for Determining Air Content of Freshly Mixed Concrete by the Pressure Method
Verified Date: 11/22/2023
Date Tested: 10/03/2023
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Air Content 1.2 %

Test 2 of 4

DIME Test ID: 2023-10-03-103-2
Test Method: CTM 518-June 2010: Method of Test for Unit Weight of Fresh Concrete
Verified Date: 11/22/2023
Date Tested: 10/03/2023
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Unit weight of the concrete 146.8 lb/ft^3
Cement content 675.84 lb/yd^3

Test 3 of 4

DIME Test ID: 2023-10-03-103-3
Test Method: CTM 523-May 2020: Method of Test for Flexural Strength of Concrete
Verified Date: 11/22/2023
Date Tested: 11/07/2023
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of specimens 2
Unit system used? US Units
Does the testing machine measure load or stress on the beam specimen? Load
Fracture initiates in the tension surface Within the Middle Third of the Span Length
Is a beam dimensional correction factor used? No
Modulus of rupture average 750 psi
Modulus of rupture 755 psi
Modulus of rupture 2 740 psi
Age of specimen 35 days

Test 4 of 4

DIME Test ID: 2023-10-03-103-4
Test Method: CTM 533-June 2010: Method of Test for Ball Penetration in Fresh Portland Cement Concrete
Verified Date: 11/22/2023
Date Tested: 10/03/2023
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Ball penetration in freshly mixed concrete (average) 2.75 inch