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: 2025-12-18-30
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 12/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/22/2025
The quantity of what the sample constitutes: x
A brief description of the sample: 1.5" ASTM A775 Dowel Bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway
Dowel Metal Heat Number: 1202071919
Dowel Epoxy Batch Number: CV2195XZ
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: Nucor
Dowel Coater: American Highway
Release Number:
Quality Assurance Code:
Rebar Size (#):
