Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001308 DEA: 081L1804 EFIS: 0819000162
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91-13.5/16.8
Work Description: JPCP (RSC), INDIVIDUAL SLAB REPLACEMENT (RSC) & RUBBERIZED HMA.
Location Description: RIVERSIDE COUNTY IN RIVERSIDE FROM 0.6 MILE WEST OF VAN BUREN BOULEVARD OVERCROSSING TO 0.2 MILE EAST OF MADISON STREET UNDERCROSSING.
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Michael St Jacques Structure Rep.: Unknown
DIME Sample ID: 2026-02-18-4
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 Assurance
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 02/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/23/2026
The quantity of what the sample constitutes: 275 Tie Bars
A brief description of the sample: #6 x 30" Tie Bars
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Highway Products
Rebar Heat Number(s): 4400037431
Rebar Epoxy Batch Number(s): CH0665YM
Rebar Coating Specification: ASTM A775
Rebar Size (#): 6
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: Simcote
Rebar Powder Manufacturer: Sherwin Williams
Release Number:
Quality Assurance Code:
