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: 2025-08-12-9
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: 08/12/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/12/2025
The quantity of what the sample constitutes: 1200
A brief description of the sample: #6 x 30" Tie Bar Basket
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Highway Products
Rebar Heat Number(s): 4400038256
10930280
Rebar Epoxy Batch Number(s): CH0174PC
Rebar Coating Specification: ASTM A775
Rebar Size (#): 6
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: Simcote
Rebar Powder Manufacturer: Shermin Williams
Release Number: L196-001-25
Quality Assurance Code:
