Sample Record for 2026-04-21-8
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001123 DEA: 051H4704 EFIS: 0516000078
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-9-9-13.6,15.5
Work Description: REPLACE BRIDGES AND INSTALL MGS.
Location Description: SANTA CRUZ COUNTY NEAR BOULDER CREEK AT SAN LORENZO RIVER BRIDGE AND AT KINGS CREEK BRIDGE
Contractor Name: GORDON N. BALL, INC.
Contractor Address: Unknown
Resident Engineer: Gareth Gill Structure Rep.: Jarred Burrows
Sample Information
DIME Sample ID: 2026-04-21-8
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 04/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2026
The quantity of what the sample constitutes: 1 lot of 16
A brief description of the sample: #4 Rebar Coupled bars
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: C & N Reinforcing
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator:
Rebar Size: #4
Coupler Model: Double Bar Zap Screwlok
Coating Standards: ASTM A934 epoxy
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 1043
Rebar Heat Number(s): 4156763
Rebar Size 2 :
Coupler Unique ID: SB-17-02
Test Results
