Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209680 DEA: 07295504 EFIS: 0713000014
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-1.8/8.4
Work Description: REPLACE PCC PAVEMENT AND COLD PLANE AND OVERLAY.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM BEAUDRY AVENUE UNDERCROSSING TO 0.4 MILE NORTH OF PILGRIMAGE OVERCROSSING
Contractor Name: OHL USA, INC.
Contractor Address: 1920 MAIN STREET STE 310, Irvine, CA 92614
Resident Engineer: Moe Izadpanah Structure Rep.: Addis Ambaye
DIME Sample ID: 2015-07-27-1
TL Number from the TL Form: L79 PCP 001
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 07/27/2015
Date that the sample was received by the laboratory/organization performing the testing: 07/28/2015
The quantity of what the sample constitutes: 2
A brief description of the sample: 6X12
From where was the sample collected: Job Site
Laboratory sample identification: 914-01
Structure unique identifier: REPKACE PCC PAVEMENT AND COLD PLANE OVERLAY
Structure name: CASTING BED B2C PAVEMENT PANELS
The fabricator/manufacturer/facility name: JOB
The concrete mix design number: RRM 14062
The truck number from where the sample was collected: LOAD 8
The batch plant ticket number from where the sample was collected: 1096481
Concrete batch plant: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: TRUCK
Where the material sample would have been placed if not sampled: Unknown
From Lot No.:
Bag Lot No.:
DIME Test ID: 2015-07-27-1-1
Test Method: CTM 521-November 2014: Method of Test for Compressive Strength of Molded Concrete Cylinders
Verified Date: 08/24/2015
Date Tested: 08/24/2015
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Cross sectional area of cylinder 1
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28.46 in^2
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Cross sectional area of cylinder 2
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28.46 in^2
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Compressive strength (to nearest 10 psi)
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6990 psi
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Comment on any defect in either specimen or caps (Max 250 Characters)
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no data
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Correction factor for cylinder 1
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1
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Age of specimen
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28 days
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