Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001678 DEA: 101U5604 EFIS: 1025000204
QA Service Level: 1
DIST-CO-RTE-PM: 10---
Work Description: Replacement of Box Girder
Location Description:
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Chris Hanson Structure Rep.: Unknown
DIME Sample ID: 2026-04-14-12
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (213) 505-4213
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 04/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/14/2026
The quantity of what the sample constitutes: 8
A brief description of the sample: #5 Double Barrel Zap Screwlok Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Site
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: Bar Splice
Intermediate Assembler or Fabricator:
Rebar Size: #5
Coupler Model: Double Barrel Zap Screwlok
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 5247
Rebar Heat Number(s): 4149839
Rebar Size 2 :
Coupler Unique ID: SB-17-02
DIME Test ID: 2026-04-14-12-1
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Tensile Slip)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-04-14-12-2
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Tensile Slip)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
