Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000696 DEA: 061H3304 EFIS: 0625000036
QA Service Level: 1
DIST-CO-RTE-PM: 06---
Work Description:
Location Description:
Contractor Name: Chapco Construction
Contractor Address: 6000 Mortono Street, Sacramento, CA 95828
Resident Engineer: Jesse Carpenter Structure Rep.: Martin Garcia
DIME Sample ID: 2024-10-21-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 10/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/21/2024
The quantity of what the sample constitutes: 1 lot
A brief description of the sample: #10 D250L Coupler
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier: 42-0171
Structure name: Toulumne Street OC
The fabricator/manufacturer/facility name: Chapco Yard
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor Steel
Coupler Manufacturer: Dayton Superior
Intermediate Assembler or Fabricator:
Rebar Size: #10
Coupler Model: D250L
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 208550
Rebar Heat Number(s): 4000019110
Rebar Size 2 :
Coupler Unique ID: SL-17-06
