Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993798 DEA: 09366804 EFIS: 0916000021
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-395-117.3/117.9
Work Description: MEADOW FARMS ADA
Location Description: INYO COUNTY NEAR BISHOP FROM 0.1 MILE EAST OF SEE VEE LANE TO BARLOW LANE
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: P.O. BOX 2210, PISMO BEACH, CA 93448-2210
Resident Engineer: Adam Zumstein Structure Rep.: Mulugheta Belay
DIME Sample ID: 2026-03-25-61
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 TM7 - Epoxy Coated Rebar
Sample Taken Date: 03/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2026
The quantity of what the sample constitutes: 2
A brief description of the sample: Epoxy Coated Rebar
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Nucor
Rebar Heat Number(s): 12020042Y7
Rebar Epoxy Batch Number(s):
Rebar Coating Specification: ASTM A775
Rebar Size (#): 4
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: NA
Rebar Powder Manufacturer:
Release Number:
Quality Assurance Code:
