Field Sample of PCC Sample Card TL-0502

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STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD

SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID: 2017-06-01-21
CONTR. NO.: 072159U4
EFIS NO.: 0715000160
FED NO.:
DIST. 07
CO. LA,ORA
RT. 5
P.M. 0.0/1.5, 44.3/44.4
LIMITS OF WORK: CONSTRUCT HOV LANES AND MIX FLOW LANES.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.: Lalonde, Danny
ADDRESS
CONTRACTOR SECURITY PAVING COMPANY, INC.
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2017-06-01
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Bent 3 Column B
DATE SAMPLED:
2017-06-01
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 072159U4 - - 7 - 1,2/4; __ __ __ __ 06/01/2017
Cylinder Code: 072159U4 - - 28 - 3,4/4; __ __ __ __ 06/01/2017
SAMPLED BY: Manuel Alcorta
TITLE: QC Field Technician
Project DEA: 072159U4
DIME Sample ID: 2017-06-01-21