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: 2025-07-16-7
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Stock
Type of Material: SMTL TM6 - Ductile Iron Cast Samples
Sample Taken Date: 07/16/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 8
A brief description of the sample: Test Coupon for Sampling
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Schwager-Davis Inc
Heat Number (s): K083
Part Number (s): SDI196 PC1
Material Specification: A536
Grades: 80-55-06
Metal Foundry Manufacturer (Mill): Farrar Corporation
Prestressing Manufacturer: Schwager Davis inc
