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: cdot_conc.lab@state.co.us

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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4

5

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