Sample Record for 2026-02-04-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000004 DEA: 033H5604 EFIS: 0318000014
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA,NEV-20,80-VAR
Work Description: STRUCTURAL CONC, BAR REINFORCING STEEL, BRIDGE REMOVAL, HMA, AND JPCP.
Location Description: PLACER AND NEVADA COUNTIES NEAR CISCO GROVE ON ROUTE 80 FROM 0.4 MILE WEST OF LAKE VALLEY OVERCROSSING TO 0.9 MILE EAST OF YUBA PASS SEPARATION AND OVERHEAD AND ON ROUTE 20 AT YUBA PASS SEPARATION AND OVERHEAD
Contractor Name: FLATIRON WEST INC.
Contractor Address: 1200 Concord Ave Suite 465, Concord, CA 94520
Resident Engineer: Tad Sampson Structure Rep.: James 'Jimmer' Ross
Sample Information
DIME Sample ID: 2026-02-04-3
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Rocklin Construction Field Office
Sample Organization Contact: 530-330-2727
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 02/04/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Rebar Couplers
A brief description of the sample: 4 EA Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: C&N
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: C&N
Coupler Manufacturer: HRC
Intermediate Assembler or Fabricator:
Rebar Size: #14
Coupler Model: 500
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): ##
Rebar Heat Number(s): 1
Rebar Size 2 :
Coupler Unique ID: TP-17-03
Test Results
