SAMPLE LOCATION AND FIELD TEST RESULTS
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Region Item # Material placed in Line Item #'s Entrained Air Slump Concrete Temperature Yield W/C Ratio Hours Initial cure in molds Set No. Conc. Class 28 Day Break Date Number of Specimens Cylinders 4 X 8 Cubes 2 X 2 Cubic Yards Square Yards Specimen Age Area Maximum Load PSI Break Type % Aggregate Fractured IAT: Previous forms are obsolete and may not be used Lab Comments: Email: Lineal Feet Diameter 1 & 2 Electronic Signature of IA Personnel: Cell Phone No: Submitted By: FS# = (Contract ID-Seq.#) Email completed form to IA personnel Batch Ticket # Submit completed form to: [email protected] 6 X 12 Mark each specimen with Field Sheet # and Break Date Consultant Lab CDOT Field Lab Sample ID Date/Time Molds Removed Location Stored in Field: Contract ID Project Number Project Location __ __ __ __ __ -- __ __ __ __ Concrete Supplier: CDOT Mix # Description: COLORADO DEPARTMENT OF TRANSPORTATION Mold Date Concrete Cylinders Compressive Strength C39 Cubes Compressive Strength C109 Additional methods C1064, T119, T121, T152 Manner of Protection: Type of specimen submitted SAMPLE LOCATION AND FIELD TEST RESULTS Field Tester Name Final Cure Method Water at 73.5⁰ Moist Room Cure 73.5⁰ Specimen Data Placed at (Str. No. or station/lane/portion) Unit Weight Initial cure temperature (60-80⁰F) (68-78⁰F) Time Specimen for: Design Adequacy Field Cure Maintained moist and temperature by: Field Comments: For Cast specimens, report cast by Required Strength____________ psi. 28 Day Average Compressive Strength ________ psi. Date Submitted to Lab Specimens tested at: Central Lab Region Lab Represented Quantity Previous Qty Total to Date This Sheet Other: ______________ CDOT Form 82 2/18 Upload completed form into the attachment icon for the sample record Cylinder Compressive Strength Results Break Date Non-SMM/LIMS: Completed form in materials book For specimens submitted to Central Lab: SMM/LIMS: Place IA Stamp Here: 1 2 3 4 5 6 7
Transcript of SAMPLE LOCATION AND FIELD TEST RESULTS
Region
Item #
Material placed in Line Item #'s
Entrained Air Slump Concrete Temperature Yield W/C Ratio
Hours Initial cure
in molds
Set No. Conc. Class28 Day
Break Date
Number of
Specimens
Cylinders 4 X 8 Cubes 2 X 2
Cubic Yards
Square Yards
Specimen Age Area
Maximum
Load PSI
Break
Type % Aggregate
Fractured
IAT:
Previous forms are obsolete and may not be used
Lab Comments:
Email:
Lineal Feet
Diameter
1 & 2
Electronic Signature of IA Personnel:Cell Phone No:Submitted By:
FS# = (Contract ID-Seq.#)
Email completed form to IA personnel
Batch Ticket #
Submit completed form to: [email protected]
6 X 12
Mark each specimen with Field Sheet # and Break Date
Consultant Lab
CDOT Field Lab
Sample ID
Date/Time Molds RemovedLocation Stored in Field:
Contract ID
Project Number
Project Location
__ __ __ __ __ -- __ __ __ __
Concrete Supplier: CDOT Mix # Description:
COLORADO DEPARTMENT OF TRANSPORTATION
Mold Date
Concrete Cylinders Compressive Strength C39
Cubes Compressive Strength C109
Additional methods C1064, T119, T121, T152
Manner of Protection:
Type of specimen submitted
SAMPLE LOCATION AND FIELD TEST RESULTS
Field Tester Name
Final Cure Method
Water at 73.5⁰
Moist Room Cure 73.5⁰
Specimen Data
Placed at (Str. No. or station/lane/portion)
Unit Weight
Initial cure temperature
(60-80⁰F)
(68-78⁰F)
Time Specimen for:
Design Adequacy
Field CureMaintained moist and temperature by:
Field Comments:
For Cast specimens, report cast by
Required Strength____________ psi.
28 Day Average Compressive Strength ________ psi.
Date Submitted to Lab Specimens tested at:
Central Lab
Region Lab
Represented Quantity
Previous Qty Total to DateThis Sheet
Other: ______________
CDOT Form 82 2/18
Upload completed form into the
attachment icon for the sample record
Cylinder Compressive Strength Results
Break Date
Non-SMM/LIMS: Completed form in materials book
For specimens submitted to Central Lab:SMM/LIMS:
Place IA Stamp Here:
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