Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-06-13-70
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Authorization
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 06/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2025
The quantity of what the sample constitutes: NA
A brief description of the sample: 1-1/4 inch, ASTM A722 , Grade 150 Ksi Threaded bar anchorage system
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: William Form Engineering
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type: Deformed
Rebar Size: #10
Nut Specification for Threaded Bar: ASTM E112
System Manufacturer: William Forms
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: Uncoated
Bar Heat Number(s): 58061592
Nut Heat Number(s): 90818
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s): C228246
Coupler Grade:
DIME Test ID: 2025-06-13-70-1
Test Method: ASTM A722-18: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
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
Data has not been verified.
