Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2025-01-17-3
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 - Threaded Bar
Sample Taken Date: 01/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/28/2025
The quantity of what the sample constitutes: 1-50
A brief description of the sample: 1-3/8" 150 KSI All thread bar and hardware
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering-SD
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A772
Threaded Bar Grade: 722
Threaded Bar Type: Plain
Rebar Size:
Nut Specification for Threaded Bar: ASTM A29
System Manufacturer: Willaims Form Engineering SD
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: Uncoated
Bar Heat Number(s): 58052325
Nut Heat Number(s): 79002105
Bar Lot Number: 58052325
Nut Lot Number: 79002105
Coupler Heat Number(s):
Coupler Grade:
DIME Test ID: 2025-01-17-3-1
Test Method: ASTM A722-18: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
Data has not been verified.
