Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000357 DEA: 07341304 EFIS: 0717000187
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Francisco J Martinez Structure Rep.: Unknown
DIME Sample ID: 2025-01-20-24
TL Number from the TL Form:
Sample Submitted By Organization: LAC Metro
Sample Organization Contact: (213) 418-3291
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 01/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/20/2025
The quantity of what the sample constitutes: 13,740 LF
A brief description of the sample: 1 1/2" x 18" Fully Epoxy Coated Loose Dowel Bars
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway
Rebar Heat Number(s): 1202063736
Rebar Epoxy Batch Number(s):
Rebar Coating Specification: ASTM A775
Rebar Size (#): 1 1/2"
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: American Highway
Rebar Powder Manufacturer:
Release Number:
Quality Assurance Code:
