Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001075 DEA: 040W0304 EFIS: 0420000164
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-580-0.02/6.3
Work Description: Replace existing tolling structure with open road tolling (ORT) system at the Richmond-San Rafael.
Location Description:
Contractor Name: FLATIRON WEST INC.
Contractor Address: 1200 Concord Ave Suite 465, Concord, CA 94520
Resident Engineer: William Sommer Structure Rep.: Alyssa Inocencio
DIME Sample ID: 2026-01-12-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 01/12/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 Lot of 146
A brief description of the sample: 3'-6" dia. hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: Toll Plaza Reconfiguration
The fabricator/manufacturer/facility name: Conco Companies Benicia
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 167324
Hoop Manufacturer Lot Number(s): H01
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 3'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Cascade
Welding Company: Conco Companies Benicia
Coating Standards: Uncoated
Weld Type: Flash Welded
