Sample Record for 2017-11-08-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211573 DEA: 050Q6004 EFIS: 0500020290
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-17-1.0/1.4
Work Description: ACACIA ERADICATION AND SLOPE STABILIZATION WITH ROADWAY WORK.
Location Description: SANTA CRUZ COUNTY NEAR SANTA CRUZ FROM 0.2 MILE NORTH OF PASATIEMPO OVERCROSSING TO BEULAH PARK UNDERCROSSING
Contractor Name: Graniterock Company
Contractor Address: 411 Walker Street, Watsonville, CA 95077
Resident Engineer: Bertha Roman Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2017-11-08-1
TL Number from the TL Form: C719148
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Verification
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 11/08/2017
Date that the sample was received by the laboratory/organization performing the testing: 11/09/2017
The quantity of what the sample constitutes: 2
A brief description of the sample: A615 Gr.75 HDG threaded bar w/A108 HDG nut
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Eng
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): NF15102802
Head Manufacturer Lot Number(s): none
Rebar Size: 6
Headed Bar Model Name: none
Size of Head: Full Size - 9x
Head Connection Type: Threaded
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: mittal
Head Fabricator: none
Material Standard Code: ASTM A615
Headed Bar Unique ID:
Test Results
