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: 2026-03-24-12
TL Number from the TL Form: L196-029-26
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 Dowels
Sample Taken Date: 03/24/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2
A brief description of the sample: 1.5" Dowel Bar Baskets
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RV Concrete
Dowel Metal Heat Number: Dowel 120206641620
Wire 1000229536
Dowel Epoxy Batch Number: CH055KT CH0205CW CH0315JB
Dowel Coating Specification: ASTM A884
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: NUCOR
Dowel Coater: American Highway
Release Number:
Quality Assurance Code:
Rebar Size (#):
