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: 2015-09-02-11
CONTR. NO.: 041A2904
EFIS NO.: 0400000482
FED NO.:
DIST. 04
CO. SON
RT. 12
P.M. 9.6
LIMITS OF WORK: REPLACE BRIDGE AND WIDEN APPROACHES.
LOCATION OF POUR:
RES. ENG. OR SUPT: Syd Valeh
STRUCTURES DEPT. REP.: Chi, Jonathan
ADDRESS
CONTRACTOR GHILOTTI CONSTRUCTION COMPANY
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2015-09-02
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Unknown
DATE SAMPLED:
2015-09-02
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
Cylinder Code: 041A2904 - - 28 - 1,2/2; __ __ __ __ 09/02/2015
SAMPLED BY: Keith Iwamoto
TITLE: Unknown
Project DEA: 041A2904
DIME Sample ID: 2015-09-02-11