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Sample Record for 2025-05-08-5

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Project Information

Project ID: 1000004 DEA: 033H5604 EFIS: 0318000014 QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA,NEV-20,80-VAR
Work Description: STRUCTURAL CONC, BAR REINFORCING STEEL, BRIDGE REMOVAL, HMA, AND JPCP.
Location Description: PLACER AND NEVADA COUNTIES NEAR CISCO GROVE ON ROUTE 80 FROM 0.4 MILE WEST OF LAKE VALLEY OVERCROSSING TO 0.9 MILE EAST OF YUBA PASS SEPARATION AND OVERHEAD AND ON ROUTE 20 AT YUBA PASS SEPARATION AND OVERHEAD
Contractor Name: FLATIRON WEST INC.
Contractor Address: 1200 Concord Ave Suite 465, Concord, CA 94520
Resident Engineer: Tad Sampson Structure Rep.: James 'Jimmer' Ross

Sample Information

DIME Sample ID: 2025-05-08-5
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 TM7 - Epoxy Coated Rebar
Sample Taken Date: 05/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/12/2025
The quantity of what the sample constitutes: 3,555 LBS
A brief description of the sample: ASTM A706 Grade 60 #3 size rebar - epoxy coated - ASTM A775
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Coatings Ogden, UT

Material Information

Rebar Heat Number(s): 283924, 284024, 284124
Rebar Epoxy Batch Number(s): CH1414WL, CH3374UX
Rebar Coating Specification: ASTM A775
Rebar Size (#): 3
Rebar Coating Color: Green
Rebar Manufacturer: Cascade Steel Oregon
Rebar Coater: Western Coatings Eugene OR
Rebar Powder Manufacturer: Sherwin Williams
Release Number: 117
Quality Assurance Code:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2025-05-08-5-1
Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)
Verified Date: 05/30/2025
Date Tested: 05/23/2025
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
General Comments for this Test: Tested by Atlas lab
Test Result Compliance:
Additional Comments When Verified:
Holidays Per Linear Foot of Bar no data0 holiday per ft
Holiday Test Pass/Fail Pass
Bend Test Pass/Fail Pass

Test 2 of 2

DIME Test ID: 2025-05-08-5-2
Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)
Verified Date: 05/30/2025
Date Tested: 05/23/2025
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
General Comments for this Test: Tested by Atlas Lab
Test Result Compliance:
Additional Comments When Verified:
Holidays Per Linear Foot of Bar no data0 holiday per ft
Holiday Test Pass/Fail Pass
Bend Test Pass/Fail Pass