Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000409 DEA: 051S1604 EFIS: 0524000176
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-1-60
Work Description: Rocky Creek Slip Out Permanent Restoration Project
Location Description:
Contractor Name: Gordon N Ball, Inc. (Fred Velasco/Stuart Yamamoto)
Contractor Address: 333 Camille Avenue, Alamo, CA 94507
Resident Engineer: Jorge Uberhuaga Structure Rep.: Daniel Dait
DIME Sample ID: 2024-10-17-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 10/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/17/2024
The quantity of what the sample constitutes: 60
A brief description of the sample: #8 x 4' diameter hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 096524
Hoop Manufacturer Lot Number(s): 4
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #8
Diameter of Hoop: 4'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Cascade - Oregon
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
