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.
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)
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD
SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID:
2015-08-14-13
CONTR. NO.: 07215954
EFIS NO.: 0700001835
FED NO.:
DIST. 07
CO. LA
RT. 5
P.M. 0.0/7.6
LIMITS OF WORK: WIDENING FREEWAY AND RECONSTRUCT OVERHEAD AND OVERCROSSING STRUCTURES
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.: Tsagie, Amare
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:
2015-08-14
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
CIDH Pile SW 313
DATE SAMPLED:
2015-08-14
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 07215954 - - 7 - 1,2/4; __ __ __ __ 08/14/2015
Cylinder Code: 07215954 - - 28 - 3,4/4; __ __ __ __ 08/14/2015
SAMPLED BY: David Illescas
TITLE:
QC Field Technician