Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994901 DEA: 112T3434 EFIS: 1120000081
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-5.1/8.3
Work Description: SOUNDWALLS, WIDEN FREEWAY, STRUCTURES, LANDSCAPE AND ELECTRICAL.
Location Description: SAN DIEGO COUNTY IN CHULA VISTA FROM PALOMAR STREET OVERCROSSING TO 0.5 MILE NORTH OF BONITA ROAD UNDERCROSSING
Contractor Name: WALSH CONSTRUCTION COMPANY II, LLC
Contractor Address: 1260 Corona Pointe Court #201
Resident Engineer: Tan Cao Structure Rep.: Daniela Gomez
DIME Sample ID: 2025-07-17-11
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 Dowels
Sample Taken Date: 07/17/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 200 pcs.
A brief description of the sample: Epoxy Coated Dowel Bar1.5" x 18"
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Highway Products
Dowel Metal Heat Number: 4400037190
Dowel Epoxy Batch Number: AL63996NA
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: Nucor
Dowel Coater: Simcote
Release Number:
Quality Assurance Code:
Rebar Size (#):
