Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-03-04-3
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: 03/04/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 Coated, 1 Bare.
A brief description of the sample: #6 x 30" Epoxy Coated Tie Bars
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fletcher Coating Company
Rebar Heat Number(s): 4145918
Rebar Epoxy Batch Number(s): CH0705MG
Rebar Coating Specification: ASTM A934
Rebar Size (#): 6
Rebar Coating Color: Purple
Rebar Manufacturer: CMC Steel Arizona
Rebar Coater: Sherwin Williams
Rebar Powder Manufacturer: Sherwin Williams
Release Number:
Quality Assurance Code:
