Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000403 DEA: 120K91U4 EFIS: 1222000031
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-91-R9.2/R11.4
Work Description: CONST BRIDGES, RW, SW, PAVEMENT, DRAINAGE AND ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY IN ANAHEIM FROM 0.9 MILE WEST TO 1.3 MILES EAST OF LAKEVIEW AVENUE OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 16700 Valley View Avenue Suite 300
Resident Engineer: Steve Kinaly Structure Rep.: Wei-Jen Lee
DIME Sample ID: 2025-10-23-2
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 Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 10/23/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4
A brief description of the sample: #9/29 mm. HRC 150 T-Heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp, Fountain Valley, CA
Production or Authorization Testing: Authorization Testing
Rebar Heat Number(s): 9008944
Head Manufacturer Lot Number(s): Lot 1
Rebar Size: #9
Headed Bar Model Name: HRC 150 T Heads
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Circular
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: Nucor
Head Fabricator: Nucor
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-04
