Field Sample of PCC Sample Card TL-0502

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There are 1 TL-502 form(s) generated.
STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD

SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID: 2019-03-07-10
CONTR. NO.: 07138204
EFIS NO.: 0700000142
FED NO.:
DIST. 07
CO. LA
RT. 47,103
P.M. 3.5/4.6,0.0/1.1
LIMITS OF WORK: REPLACE STEEL BRIDGE WITH CIP PS CONCRETE BOX GIRDER BRIDGE AND RAMPS.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.: Chen, Andy
ADDRESS
CONTRACTOR M C M CONSTRUCTION INC
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2019-03-07
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
152 cy
DATE SAMPLED:
2019-03-07
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 07138204 - - 11 - 1,2/6; __ __ __ __ 03/07/2019
Cylinder Code: 07138204 - - 28 - 3,4/6; __ __ __ __ 03/07/2019
Cylinder Code: 07138204 - - 42 - 5,6/6; __ __ __ __ 03/07/2019
SAMPLED BY: Matt Bruce
TITLE: ASR
Project DEA: 07138204
DIME Sample ID: 2019-03-07-10
DIME Test ID: 2019-03-07-10-1

DIME Test ID: 2019-03-07-10-2

DIME Test ID: 2019-03-07-10-3