CDOT Form 84 "Concrete Cylinders Split Tensile C496, Drilled Test Cores and Shotcrete T24" - Colorado

What Is CDOT Form 84?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 84 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 84 "Concrete Cylinders Split Tensile C496, Drilled Test Cores and Shotcrete T24" - Colorado

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FS# = (Contract ID-Seq.#)
Contract ID
Region
--
COLORADO DEPARTMENT OF TRANSPORATION
__ __ __ __ __
__ __ __ __
Concrete Cylinders Split Tensile C496
Project Number
Drilled Test Cores and Shotcrete T24
Project Location
Additional method T152
Concrete Supplier:
CDOT Mix #
Item #
Description:
SAMPLE LOCATION AND FIELD TEST RESULTS
Cores taken at: (Station/lane or structure number/location)
Cores for CP 65:
Compressive Strength Method A
Flexural Strength
Method B
Specimen Data
Specimen for:
Cored Date:
Time:
Condition specimen
Break Date:
Time:
Specimens shall be
Split Tensile
according to T 24, section
tested 24-48 hours after
Drilled Cores
7.3.1
removal
Mold Date:
Time:
Cored Date:
Date Submitted for testing:
Specimen for:
Shotcrete specimens shall
be submitted in Sealed
Shotcrete
Plastic Bags
Batch Ticket #
Entrained Air for Shotcrete:
Field Tester Name:
Field Comments:
Mark each specimen with Field Sheet # and Break Date
Set No.
Conc. Class
Number of Specimens
Required Strength __________ psi.
Sample ID
Specimens tested at:
Date Submitted to Lab
Average Reported Strength __________ psi
Central Lab
Consultant Lab
Region Lab
CDOT Field Lab
Type of specimen submitted
Cylinders
Drilled Cores
4 X 8
6 X 12
Other
__________
Previous Qty
This Sheet
Total to Date
Cubic Yards
Represented Quantity
Square Feet
Square Yards
Strength Results
Average
Average
Capped
Maximum
Break
% Aggregate
Trimmed
Diameter
Area
Length
Load
Type
Specimen
Break Date
Age
PSI
Fractured
Length
1
2
3
Corresponding Flexural
Split Tensile (CP 65)
Average PSI
Strength from linear equation
_____________ PSI
Lab Comments:
Place IA Stamp Here:
Electronic Signature of IA Personnel:
Submitted By:
Cell Phone No:
Email:
IAT:
Email completed form to IA personnel
Upload completed form into the
SMM/LIMS:
For specimens submitted to Central Lab:
attachment icon for the sample record
Submit completed form to: cdot_conc.lab@state.co.us
Non-SMM/LIMS: Completed form in materials book
4/18
Previous forms are obsolete and may not be used
CDOT Form 84
FS# = (Contract ID-Seq.#)
Contract ID
Region
--
COLORADO DEPARTMENT OF TRANSPORATION
__ __ __ __ __
__ __ __ __
Concrete Cylinders Split Tensile C496
Project Number
Drilled Test Cores and Shotcrete T24
Project Location
Additional method T152
Concrete Supplier:
CDOT Mix #
Item #
Description:
SAMPLE LOCATION AND FIELD TEST RESULTS
Cores taken at: (Station/lane or structure number/location)
Cores for CP 65:
Compressive Strength Method A
Flexural Strength
Method B
Specimen Data
Specimen for:
Cored Date:
Time:
Condition specimen
Break Date:
Time:
Specimens shall be
Split Tensile
according to T 24, section
tested 24-48 hours after
Drilled Cores
7.3.1
removal
Mold Date:
Time:
Cored Date:
Date Submitted for testing:
Specimen for:
Shotcrete specimens shall
be submitted in Sealed
Shotcrete
Plastic Bags
Batch Ticket #
Entrained Air for Shotcrete:
Field Tester Name:
Field Comments:
Mark each specimen with Field Sheet # and Break Date
Set No.
Conc. Class
Number of Specimens
Required Strength __________ psi.
Sample ID
Specimens tested at:
Date Submitted to Lab
Average Reported Strength __________ psi
Central Lab
Consultant Lab
Region Lab
CDOT Field Lab
Type of specimen submitted
Cylinders
Drilled Cores
4 X 8
6 X 12
Other
__________
Previous Qty
This Sheet
Total to Date
Cubic Yards
Represented Quantity
Square Feet
Square Yards
Strength Results
Average
Average
Capped
Maximum
Break
% Aggregate
Trimmed
Diameter
Area
Length
Load
Type
Specimen
Break Date
Age
PSI
Fractured
Length
1
2
3
Corresponding Flexural
Split Tensile (CP 65)
Average PSI
Strength from linear equation
_____________ PSI
Lab Comments:
Place IA Stamp Here:
Electronic Signature of IA Personnel:
Submitted By:
Cell Phone No:
Email:
IAT:
Email completed form to IA personnel
Upload completed form into the
SMM/LIMS:
For specimens submitted to Central Lab:
attachment icon for the sample record
Submit completed form to: cdot_conc.lab@state.co.us
Non-SMM/LIMS: Completed form in materials book
4/18
Previous forms are obsolete and may not be used
CDOT Form 84