Project Information

Project ID: 993798 DEA: 09366804 EFIS: 0916000021 QA Service Level: 1

DIST-CO-RTE-PM: 09-INY-395-117.3/117.9

Work Description: MEADOW FARMS ADA

Location Description: INYO COUNTY NEAR BISHOP FROM 0.1 MILE EAST OF SEE VEE LANE TO BARLOW LANE

Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.

Contractor Address: P.O. BOX 2210, PISMO BEACH, CA 93448-2210

Resident Engineer: Adam Zumstein Structure Rep.: Mulugheta Belay

Sample Information

DIME Sample ID: 2025-12-26-3

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 Rebar

Sample Taken Date: 12/26/2025

Date that the sample was received by the laboratory/organization performing the testing: 01/07/2026

The quantity of what the sample constitutes: 526 LBS

A brief description of the sample: #6 ASTM A706 Grade 80 With ASTM A775 Epoxy Coating

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Western Coatings Ogden, UT

Material Information

Rebar Heat Number(s): 4137170

Rebar Epoxy Batch Number(s): AA74735NA

Rebar Coating Specification: ASTM A775

Rebar Size (#): #6

Rebar Coating Color: Green

Rebar Manufacturer: Nucor

Rebar Coater: Western Coatings

Rebar Powder Manufacturer: Azkonobel

Release Number:

Quality Assurance Code:

Test Results

Test 1 of 2

DIME Test ID: 2025-12-26-3-1

Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Epoxy Coating)

Submitted By Organization: Kleinfelder - Rancho Cordova

Organization Address: 3130 Kilgore Road,

Organization City: Rancho Cordova

Organization State: CA

Organization Zipcode: 95670

Organization Email: mmlee@kleinfelder.com

Organization Phone: (916) 308-3701

Data has not been verified.

Test 2 of 2

DIME Test ID: 2025-12-26-3-2

Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)