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: 2023-07-17-45
CONTR. NO.: 050N72U4
EFIS NO.: 0520000169
FED NO.:
DIST. 05
CO. SB
RT. 101
P.M. 4.4/R7.7
LIMITS OF WORK: Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitati
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR GRANITE CONSTRUCTION COMPANY
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2023-07-17
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
Discharge from concrete truck into wheelbarrow
DATE SAMPLED:
2023-07-17
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
 
SAMPLED BY: Dorell Harper
TITLE: (no data available)
Project DEA: 050N72U4
DIME Sample ID: 2023-07-17-45