Sample Record for 2026-05-22-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001361 DEA: 120M9704 EFIS: 1213000099
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-11.5/12.5
Work Description: CONST BRIDGES, RET WALLS, JPCP, HMA, CONC BARRIERS AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN ORANGE AND ANAHEIM FROM 0.2 MILE SOUTH OF ORANGEWOOD AVENUE UNDERCROSSING TO KATELLA AVENUE UNDERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: Unknown
Resident Engineer: Aythem Al-Saleh Structure Rep.: Mohammad Rousta
Sample Information
DIME Sample ID: 2026-05-22-2
TL Number from the TL Form:
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 TM5 - Headed Bars
Sample Taken Date: 05/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/28/2026
The quantity of what the sample constitutes: 3122 120 T Heads
A brief description of the sample: ASMT A706 #5 rebar w/ 120 T heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC - Fountain Valley, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 137526
Head Manufacturer Lot Number(s): Lot 1, Lot 6, Lot 11, Lot 16, Lot 21
Rebar Size: #5
Headed Bar Model Name: HRC 120
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Square
Rebar Manufacturer: Cascade Steel Rolling Mills - Oregon
Head Manufacturer: Nucor Cold Finish Utah
Head Fabricator: HRC Fountain Valley CA
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
Test Results
