Field Sample of PCC Sample Card TL-0502
All in one One per test
Please note that the data entered on this TL-0502 form will not be saved. It will, however, be displayed when printing.
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)
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD
SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID:
2023-10-05-111
CONTR. NO.: 07307104
EFIS NO.: 0714000213
FED NO.:
DIST. 07
CO. LA
RT. 101
P.M. 32.8
LIMITS OF WORK: CONSTRUCT BRIDGE.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR CA Rasmussen
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2023-10-05
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Bed 9 from Front Discharge Ready Mix Truck
DATE SAMPLED:
2023-10-05
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 07307104 - - 2 - 1,2,3/9; __ __ __ __ 10/05/2023
Cylinder Code: 07307104 - - 7 - 4,5,6/9; __ __ __ __ 10/05/2023
Cylinder Code: 07307104 - - 28 - 7,8,9/9; __ __ __ __ 10/05/2023
SAMPLED BY: Edward Sandoval
TITLE:
QC Inspector Technician
