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: 2022-08-27-16
CONTR. NO.: 04160304
EFIS NO.: 0400000429
FED NO.:
DIST. 04
CO. ALA
RT. 84
P.M. 13.1/13.5
LIMITS OF WORK: NILES CANYON ALAMEDA CREEK BRIDGE REPLACEMENT
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR VIKING CONSTRUCTION COMPANY, INC.
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2022-08-27
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Concrete truck
DATE SAMPLED:
2022-08-27
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 04160304 - - 16 - 1,2/2; __ __ __ __ 08/27/2022
SAMPLED BY: Tristan Sayre
TITLE: ASR
Project DEA: 04160304
DIME Sample ID: 2022-08-27-16