Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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: Ian Nguyen Structure Rep.: Jarred Burrows
DIME Sample ID: 2026-05-21-65
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 TM5 - Threaded Bar
Sample Taken Date: 05/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2026
The quantity of what the sample constitutes: 4
A brief description of the sample: Coupler #8 rebar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC CMC Rebar
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A706
Threaded Bar Grade: 60
Threaded Bar Type:
Rebar Size: M25
Nut Specification for Threaded Bar: NA
System Manufacturer: HRC
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: Uncoated
Bar Heat Number(s): 5395277
Nut Heat Number(s): NA
Bar Lot Number: 9012623
Nut Lot Number: NA
Coupler Heat Number(s): A254329, 79001741
Coupler Grade: 8
