Field Sample of PCC Sample Card TL-0502

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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)
DIME
DIME Sample ID: 2016-06-23-4
CONTR. NO.: 08043514
EFIS NO.: 0800000010
FED NO.:
DIST. 08
CO. SBD
RT. 58
P.M. R22.2/R31.1
LIMITS OF WORK: REALIGN AND WIDEN 2 TO 4 LANES EXPRESSWAY
LOCATION OF POUR:
RES. ENG. OR SUPT: Shaine Shahidi
STRUCTURES DEPT. REP.: Ahmad Ankir
ADDRESS
CONTRACTOR Skanska Civil USA
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2016-06-23
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
NA
DATE SAMPLED:
2016-06-23
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 08043514 - - 7 - 1,2/2; __ __ __ __ 06/23/2016
SAMPLED BY: Mike Nunez
TITLE: QC Tech
Project DEA: 08043514
DIME Sample ID: 2016-06-23-4