Sample Record for 2026-02-06-43
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995534 DEA: 120T8604 EFIS: 1222000109
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-2.3/19.9
Work Description: APPLY METHACRYLATE AND POLYESTER CONCRETE & REPLACE JOINT SEALS.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM AVENIDA PRESIDIO UNDERCROSSING TO LAKE FOREST DRIVE OVERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Jose Berrios Structure Rep.: Justin Moy
Sample Information
DIME Sample ID: 2026-02-06-43
TL Number from the TL Form:
Sample Submitted By Organization: Peterson-Chase Gen Eng Construction, Incorporated
Sample Organization Contact: (949) 252-0441
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 02/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/06/2026
The quantity of what the sample constitutes: 12
A brief description of the sample: #5 rebar coupler samples
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier: 55-0231
Structure name: Junipero Serra UC
The fabricator/manufacturer/facility name: Rouch Rebar, Inc.
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Cascade
Coupler Manufacturer: OCM
Intermediate Assembler or Fabricator:
Rebar Size: #5
Coupler Model: O-S Splice Clip
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 81003123
Rebar Heat Number(s): 31226
Rebar Size 2 :
Coupler Unique ID: WT-17-01
Test Results
