Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994675 DEA: 07390204 EFIS: 0722000334
QA Service Level: 1
DIST-CO-RTE-PM: 07---
Work Description:
Location Description:
Contractor Name: Skanska
Contractor Address: 1995 Agua Mansa Rd, Riverside, CA 92509
Resident Engineer: Sam Gallardo Structure Rep.: Sami Deeb
DIME Sample ID: 2025-04-29-5
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 TM6 - Steel Check Sample Plate
Sample Taken Date: 04/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/29/2025
The quantity of what the sample constitutes: 1
A brief description of the sample: Steel Check Plate
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Job Site
DIME Test ID: 2025-04-29-5-1
Test Method: ASTM A370-20: Standard Test Methods and Definitions for Mechanical Testing of Steel Products (Tensile - Round Sample)
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
DIME Test ID: 2025-04-29-5-2
Test Method: ASTM E23-18: Standard Test Methods for Notched Bar Impact Testing of Metallic Materials (Charpy Impact)
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
DIME Test ID: 2025-04-29-5-3
Test Method: ASTM E18-20: Standard Test Methods for Rockwell Hardness of Metallic Materials (Hardness)
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
DIME Test ID: 2025-04-29-5-4
Test Method: SMTL CHEM-16: Steel Chemistry Analysis
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
