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: 2021-06-09-13
CONTR. NO.: 040J6424
EFIS NO.: 0414000476
FED NO.:
DIST. 04
CO. SON
RT. 101
P.M. 32.8/R54.2
LIMITS OF WORK: CRACK, SEAT AND OVERLAY WITH RHMA AND HMA, AND REPLACE CULVERTS.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR O.C. JONES & SONS, INC.
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2021-06-09
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Travelling Bucket
DATE SAMPLED:
2021-06-09
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 040J6424 - - 1 - 1,2/7; __ __ __ __ 06/09/2021
Cylinder Code: 040J6424 - - 7 - 3,4/7; __ __ __ __ 06/09/2021
Cylinder Code: 040J6424 - - 28 - 5,6,7/7; __ __ __ __ 06/09/2021
SAMPLED BY: Avery Flores
TITLE: Quality Control Manager
Project DEA: 040J6424
DIME Sample ID: 2021-06-09-13