Sample Record for 2024-10-31-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000078 DEA: 051P2804 EFIS: 0522000016
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR,-1-17.02/17.02
Work Description: REPLACE SEPARATION BRIDGE GIRDER.
Location Description: SANTA CRUZ COUNTY IN SANTA CRUZ AT ROUTE 1 NORTHBOUND/17 SEPARATION
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Ian Nguyen Structure Rep.: Stephen Pozzo
Sample Information
DIME Sample ID: 2024-10-31-2
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 - Headed Bars
Sample Taken Date: 10/31/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/31/2024
The quantity of what the sample constitutes: 8
A brief description of the sample: #9 HRC 150 T-Heads
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp, Fountain Valley, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4137349
Head Manufacturer Lot Number(s): 1
Rebar Size: #9
Headed Bar Model Name: HRC 150 THeads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: HRC Fountain Valley
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A615
Headed Bar Unique ID: 9FW-17-04
Test Results
