Field Sample of Portland Cement Concrete Sample Card TL-502
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State of California - Department of Transportation
Field Sample of Portland Cement Concrete
DIME
Sample Card
TL-0502 (REV. 9/13)
No:
Contr No.
EFIS No.
Fed No.
Dist.
Co.
Rt.
P.M.
Limits of Work:
Location of Pour:
Res. Eng. or Supt:
Structures Dept. Rep.:
Address:
Contractor:
Source of Materials
Cement
Certificate No.
Fine Aggregate
SMARA
Coarse Aggregate
SMARA
Field Sample No.
Truck No.
Ticket No.
Date Cast:
Ambient Temp.
Concrete Temp.
Size of Specimen - Inches
Cement - LB/CY
Water - LB/CY
Sampled From
Date Sampled:
Yards Placed at Time of Sampling:
Admixture:
Remarks: (Mandatory - Please attach approved mix design)
Cylinder Code:
Sampled by:
Title: