Sample Record for 2026-06-16-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000258 DEA: 042K3604 EFIS: 0416000410
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-116-9.6
Work Description: REPAIR SIDE SLOPE AND CONSTRUCT SOIL NAIL WALL.
Location Description: SONOMA COUNTY NEAR MONTE RIO AT 0.2 MILE WEST OF CNOPIUS ROAD
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Leonard Brajnikoff Structure Rep.: Alireza Jamalipour
Sample Information
DIME Sample ID: 2026-06-16-18
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 - Threaded Bar
Sample Taken Date: 06/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2026
The quantity of what the sample constitutes: 12
A brief description of the sample: #11 Threaded Bar
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering-SD
Material Information
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size: #11
Nut Specification for Threaded Bar: ASTM A29/A108
System Manufacturer: Gerdau
Epoxy Coating Color: Purple
Threaded Bar Application: Threaded Bar
Coating Standards: ASTM A123 galvanized
Bar Heat Number(s): 1000134063, 1000134062, 1000235070, 100013325
Nut Heat Number(s): 79000945, 74124863
Bar Lot Number: 100013406340, 100013406240, 100023507040, 100
Nut Lot Number: 11N7D, 11N5D
Coupler Heat Number(s): 256841-11G4D, 20856910-11D2D
Coupler Grade: 75
Test Results
