Sample Record for 2025-12-18-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993678 DEA: 042Q8004 EFIS: 0419000050 COOP: 042836,042944
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101,92-US 101 & SR 92-10.9/12.1 & 11.8/13.4
Work Description: US 101/SR 92 INTERCHANGE AREA IMPROVEMENT :PROJECT WILL CONSTRUCT CONGESTION RELIEF IMPROVEMENTS AT THE US 101/SR 92 INTERCHANGE AREA.
Location Description:
Contractor Name: GORDON N. BALL, INC.
Contractor Address: 333 CAMILLE AVENUE, ALAMO, CA 94507
Resident Engineer: Mohamed Fouad Structure Rep.: Bryan Nagid
Sample Information
DIME Sample ID: 2025-12-18-3
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: 12/18/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 64 bars size #6 / 88 HRC 150 T Heads
A brief description of the sample: ASTM A706 Grade 60 rebar welded to HRC 150 T-Heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC - Fountain Valley
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4146853
Head Manufacturer Lot Number(s): 100012688320
Rebar Size: #6
Headed Bar Model Name: HRC 150 T Heads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: CMC - AZ
Head Manufacturer: Nucor Wisconsin
Head Fabricator: HRC Fountain Valley CA
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-04
Test Results
