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.

STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
FIELD SAMPLE OF PORTLAND CEMENT CONCRETE
SAMPLE CARD

SRL-TL-0502 (REV.9/13)
DIME
DIME Sample ID: 2022-09-27-63
CONTR. NO.: 072332E4
EFIS NO.: 0700000391
FED NO.:
DIST. 07
CO. LA
RT. I-5
P.M. 45.4/54
LIMITS OF WORK: Addition of 14 miles of HOV lanes in both directions would extend existing carpool lanes on the I- 5 in San Fernando Valley to Santa Clarita Valley
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR Not yet Awarded
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2022-09-27
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
RW 2674 footings
DATE SAMPLED:
2022-09-27
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
SAMPLED BY: Robert Ang
TITLE: (no data available)
Project DEA: 072332E4
DIME Sample ID: 2022-09-27-63