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)
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD
SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID:
2020-10-27-9
CONTR. NO.: 043Q3004
EFIS NO.: 0419000197
FED NO.:
DIST. 04
CO. SON
RT. 121
P.M. 10.3/11.2
LIMITS OF WORK:
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2020-10-27
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
headwall footing culvert 1
DATE SAMPLED:
2020-10-27
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 043Q3004 - - 28 - 1,2/2; __ __ __ __ 10/27/2020
SAMPLED BY: b nou
TITLE:
(no data available)