Sample Record for 2025-04-08-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995488 DEA: 051C9504 EFIS: 0513000018
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-R36.0/R37.0
Work Description: COLD PLANE AC PVMT, RHMA, LIGHTING SYSTEMS, AND REPLACE BRIDGES.
Location Description: SANTA BARBARA COUNTY ABOUT 8.0 MILES WEST OF GOLETA FROM 0.6 MILE EAST OF REFUGIO ROAD UNDERCROSSING TO 0.4 MILE WEST OF REFUGIO ROAD UNDERCROSSING.
Contractor Name: M.C.M. CONSTRUCTION, INC.
Contractor Address: 6413 32nd Street, North Highlands, CA 95660
Resident Engineer: Jacob Cooper Structure Rep.: Clifford Replogle
Sample Information
DIME Sample ID: 2025-04-08-3
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 Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 04/08/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4 of 80
A brief description of the sample: HRC 555 End Anchors
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 3500023166
Head Manufacturer Lot Number(s): 14A84/14A03
Rebar Size: #14
Headed Bar Model Name: HRC 555
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: HRC 555 T Heads
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID: 4FG-17-01
Test Results
