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)
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD
SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID:
2015-09-17-4
CONTR. NO.: 080F5404
EFIS NO.: 0800000136
FED NO.:
DIST. 08
CO. RIV
RT. 91,15
P.M. 0.0/13.04, 35.64/45.14
LIMITS OF WORK: SR-91 Corridor Improvement Project: Develop approx. 8 miles of tolled express lanes and related improvements within SR 91 between the Riverside/Orange
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.: Angha, Alex
ADDRESS
CONTRACTOR Atkinson Walsh, Joint Venture
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2015-09-17
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
LOAD 3
DATE SAMPLED:
2015-09-17
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 080F5404 - - 7 - 1,2/10; __ __ __ __ 09/17/2015
Cylinder Code: 080F5404 - - 11 - 3,4/10; __ __ __ __ 09/17/2015
Cylinder Code: 080F5404 - - 14 - 5,6/10; __ __ __ __ 09/17/2015
Cylinder Code: 080F5404 - - 21 - 7,8/10; __ __ __ __ 09/17/2015
Cylinder Code: 080F5404 - - 28 - 9,10/10; __ __ __ __ 09/17/2015
SAMPLED BY: JUANCHO SEVILLA
TITLE:
CONSULTANT TECH