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.
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:
2021-08-02-25
CONTR. NO.: 034E62U4
EFIS NO.: 0319000068
FED NO.:
DIST. 03
CO. ED
RT. 50
P.M. 18.5/24.2
LIMITS OF WORK: CONSTRUCT UC, MED BARRIER, DRAINAGE SYSTEMS & HMA OVERLAY.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR SECURITY PAVING COMPANY, INC.
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2021-08-02
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Cut off Wall
DATE SAMPLED:
2021-08-02
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
SAMPLED BY: Michael Cooper
TITLE:
(no data available)