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:
2021-06-25-21
CONTR. NO.: 010B0904
EFIS NO.: 0100020444
FED NO.:
DIST. 01
CO. DN
RT. 101
P.M. 8.2/8.7
LIMITS OF WORK: Panther Creek & Hunter Creek Bridges
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR Golden State Bridge, Inc
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2021-06-25
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Concrete sample from wheelbarrow
DATE SAMPLED:
2021-06-25
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 010B0904 - - 3 - 1,2/6; __ __ __ __ 06/25/2021
Cylinder Code: 010B0904 - - 23 - 3,4/6; __ __ __ __ 06/25/2021
Cylinder Code: 010B0904 - - 29 - 5,6/6; __ __ __ __ 06/25/2021
SAMPLED BY: Mauril Mariano
TITLE:
Quality Control Engineer