Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001723 DEA: 050N7064 EFIS: 0524000077
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-10.9/12.3
Work Description: SB 101 - Segment 4E North - Cabrillo
Location Description:
Contractor Name: Granite Construction
Contractor Address: P.O. Box. 6744, Santa Barbara, CA
Resident Engineer: Tristan Gebhart Structure Rep.: Josh Madrigal
DIME Sample ID: 2026-06-16-4
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 - Welded Hoops
Sample Taken Date: 06/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2026
The quantity of what the sample constitutes: 8
A brief description of the sample: #7, 3'-8" Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 9012357
Hoop Manufacturer Lot Number(s): 1, 4
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 3'-8"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Steel AZ
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
