Sample Record for 2025-01-08-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994901 DEA: 112T3434 EFIS: 1120000081
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-5.1/8.3
Work Description: SOUNDWALLS, WIDEN FREEWAY, STRUCTURES, LANDSCAPE AND ELECTRICAL.
Location Description: SAN DIEGO COUNTY IN CHULA VISTA FROM PALOMAR STREET OVERCROSSING TO 0.5 MILE NORTH OF BONITA ROAD UNDERCROSSING
Contractor Name: WALSH CONSTRUCTION COMPANY II, LLC
Contractor Address: 1260 Corona Pointe Court #201
Resident Engineer: Tan Cao Structure Rep.: Daniela Gomez
Sample Information
DIME Sample ID: 2025-01-08-1
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 Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 01/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/08/2025
The quantity of what the sample constitutes: 10
A brief description of the sample: #9 HY-TEN Threaded Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Cascade Steel Oregon
Coupler Manufacturer: HY Ten
Intermediate Assembler or Fabricator: Integrity Rebar Placers
Rebar Size: #9
Coupler Model: HT S Standard Coupler
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): M/245328/6552 F/245304/6577
Rebar Heat Number(s): 388822
Rebar Size 2 : 9
Coupler Unique ID: ST-23-03
Test Results
