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: 2019-07-19-14
CONTR. NO.: 08347704
EFIS NO.: 0800000616
FED NO.:
DIST. 08
CO. SBD
RT. SR-58
P.M. 0/12.9
LIMITS OF WORK: (Alternative Delivery) The CMGC project will upgrade SR 58 from 2- to 4-lanes in San Bernardino County from the Kern County line to 7.5 miles east of
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.: Abdalla, Osama
ADDRESS
CONTRACTOR KIEWIT INFRASTRUCTURE WEST CO.
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2019-07-19
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
85 cy
DATE SAMPLED:
2019-07-19
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 08347704 - - 28 - 1,2/2; __ __ __ __ 07/19/2019
SAMPLED BY: David Medina
TITLE: ASR
Project DEA: 08347704
DIME Sample ID: 2019-07-19-14
DIME Test ID: 2019-07-19-14-1