Sample Record for 2026-03-06-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001910 DEA: 044X5304 EFIS: 0426000087 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29-23.54/23.54
Work Description: REMOVE AND EXISTING CULVERT AND REPLACE WITH CAST IN PLACE BOX CULVERT AND REPAIR ROADWAY REPLACE CULVERT AND REPAIR ROADWAY
Location Description: IN NAPA CO. HWY 29 PM 23.54
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-03-06-6
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Fairfield Construction Field Office 59-545
Sample Organization Contact: 510-714-7055
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 03/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2026
The quantity of what the sample constitutes: 8
A brief description of the sample: #4 Form Saver
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: nVent Lenton Form Savers
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor
Coupler Manufacturer: nVent Lenton
Intermediate Assembler or Fabricator:
Rebar Size: #4
Coupler Model: LENTON FORM SAVER
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 4100000273
Rebar Heat Number(s): 4100000273
Rebar Size 2 :
Coupler Unique ID: ST-17-05
Test Results
Tests Assigned to this Sample
| DIME Test ID | Test Method | Assigned Date | Test Date | Assigned By | Assigned Lab | Test Comments | Assigned To |
| 2026-03-06-6-1 | CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Slip) | 03/06/2026 | Not scheduled | Tyler West | CT HQ - Sacramento Structural Materials Testing Laboratory | | |
| 2026-03-06-6-2 | CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Tensile) | 03/06/2026 | Not scheduled | Tyler West | CT HQ - Sacramento Structural Materials Testing Laboratory | | |
157615157616
