Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000279 DEA: 023H70U4 EFIS: 0223000161
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-299-15.0/25.7
Work Description: RHMA-G, HMA (TYPE A), COLD PLANE AC, & SOLDIER PILE RETAINING WALL.
Location Description: TRINITY COUNTY NEAR DEL LOMA FROM 1.0 MILE EAST OF TRINITY RIVER BRIDGE NO.05-0006 TO 0.1 MILE WEST OF PRAIRIE CREEK ROAD
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Edward Worden Structure Rep.: Mike Sears
DIME Sample ID: 2025-06-18-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 06/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/18/2025
The quantity of what the sample constitutes: 26,224 lbs
A brief description of the sample: A706 gr 80 rebar
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Coatings Ogden, UT
Rebar Heat Number(s): 3500041159
Rebar Epoxy Batch Number(s): na
Rebar Coating Specification: ASTM A775
Rebar Size (#): #5
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: Western Coating Ogden UT
Rebar Powder Manufacturer: na
Release Number:
Quality Assurance Code:
