Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001169 DEA: 07314524 EFIS: 0722000300 COOP: 075283
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description: I-105 METRO Express Lanes Project
Location Description: LA-105 PM R0.6/R10.1, LA-110 PM R14.1/R16.6
Contractor Name: Flatiron-Myers (JV)
Contractor Address: Unknown
Resident Engineer: Roger Miramontes Structure Rep.: Javid Sharifi
DIME Sample ID: 2025-04-23-3
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 04/23/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: TBD
A brief description of the sample: A615 Grade 75 Threaded Bar and Hex Nut
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dywidag Systems International
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size: #8
Nut Specification for Threaded Bar: A519
System Manufacturer: Dywidag Systems International
Epoxy Coating Color: NA
Threaded Bar Application: Soil Nail
Coating Standards: Uncoated
Bar Heat Number(s): 58063387/02, 58064732/02
Nut Heat Number(s): 73129194
Bar Lot Number: 1
Nut Lot Number: 1
Coupler Heat Number(s):
Coupler Grade:
