Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994928 DEA: 010F9704 EFIS: 0116000111
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-162-29.18/30.27
Work Description:
Location Description:
Contractor Name: Wylatti Resource Management, Inc.
Contractor Address: 23601 Cemetary Lane, Covelo, CA 95428
Resident Engineer: Roozbeh Hadipour Structure Rep.: Mostafa Bayoumi
DIME Sample ID: 2025-07-28-6
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Verification
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 07/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2025
The quantity of what the sample constitutes: 150
A brief description of the sample: HCR Couplers
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Build-Tex
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 3500039734
Head Manufacturer Lot Number(s): Unknown
Rebar Size: #9
Headed Bar Model Name: HRC670L
Size of Head: Reduced Size - 4x
Head Connection Type: Threaded
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: HRC
Head Fabricator: HRC
Material Standard Code: ASTM A706
Headed Bar Unique ID: 4FG-17-01
DIME Test ID: 2025-07-28-6-1
Test Method: ASTM A970-18: Standard Specification for Headed Steel Bars for Concrete Reinforcement (Tensile)
Verified Date: 08/14/2025
Date Tested: 08/14/2025
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:
Test Result Compliance:
Additional Comments When Verified:
|
Number of Headed Bar Samples
|
2
|
| Lot # | Area (sqin) | Peak Load (lbf) | Tensile Strength (psi) | Comments | Tested By | | 1 | 1 | 97830 | 97830 | Ok Necking | Atlas | | 1 | 1 | 79207 | 79210 | Broke at Head | Atlas |
| |
|
Temperature
|
0 f
|
|
UTM
|
NA
|
