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: 2018-03-26-12
CONTR. NO.: 040A7104
EFIS NO.: 0400000160
FED NO.:
DIST. 04
CO. ALA
RT. 880
P.M. 28.4/29.2
LIMITS OF WORK: WIDEN ROADS, RECONSTRUCT RAMPS WITH HMA, REPLACE 2 CONC OVERCROSSINGS.
LOCATION OF POUR:
RES. ENG. OR SUPT: Joy Cheung
STRUCTURES DEPT. REP.: Dabilly, Maxime
ADDRESS
CONTRACTOR RGW Construction
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2018-03-26
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
field
DATE SAMPLED:
2018-03-26
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 040A7104 - - 84 - 1,2/2; __ __ __ __ 03/26/2018
SAMPLED BY: rodeho no
TITLE: asr
Project DEA: 040A7104
DIME Sample ID: 2018-03-26-12