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:
2023-11-20-22
CONTR. NO.: 04297634
EFIS NO.: 0415000040
FED NO.:
DIST. 04
CO. ALA
RT. 84,680
P.M. 17.9/21
LIMITS OF WORK: ROUTE 84 WIDENING (4-LANE EXPRESSWAY) FROM I-680 TO PIGEON PASS, INCLUDING INTERSECTION, DRAINAGE IMPROVEMENTS AND UTILITY RELOCATION.
LOCATION OF POUR:
RES. ENG. OR SUPT:
STRUCTURES DEPT. REP.:
ADDRESS
CONTRACTOR Bay Cities Paving & Grading
SOURCE OF MATERIALS
CEMENT:
CERTIFICATE NO.:
FINE AGGREGATE:
SMARA:
COARSE AGGREGATE:
SMARA:
FIELD SAMPLE NO.:
TRUCK NO.:
TICKET NO.:
DATE CAST:
2023-11-20
AMBIENT TEMP.:
CONCRETE TEMP.:
SIZE OF SPECIMEN - INCHES:
CEMENT - LB/CY:
WATER - LB/CY:
SAMPLED From:
concrete sample from wheelbarrow
DATE SAMPLED:
2023-11-20
YARDS PLACED AT TIME OF SAMPLING:
ADMIXTURE:
REMARKS: (MANDATORY - PLEASE ATTACH APPROVED MIX DESIGN)
Cylinder Code: 04297634 - - 28 - 1,2,3/3; __ __ __ __ 11/20/2023
SAMPLED BY: Marcos Lopez
TITLE:
ASR