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: 2026-04-27-78
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 - Headed Bars
Sample Taken Date: 04/27/2026
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: Headed Bars
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rbar
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4156173
Head Manufacturer Lot Number(s): 400003476521
Rebar Size: #9
Headed Bar Model Name: HRC 150 T Heads
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Circular
Rebar Manufacturer: CMC Rebar
Head Manufacturer: Nucor
Head Fabricator: HRC
Material Standard Code: ASTM A615
Headed Bar Unique ID: 9FW-17-04
DIME Test ID: 2026-04-27-78-1
Test Method: ASTM A970-18: Standard Specification for Headed Steel Bars for Concrete Reinforcement (Tensile)
Verified Date: 06/25/2026
Date Tested: 06/25/2026
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of Headed Bar Samples
|
4
|
| Lot # | Area (sqin) | Peak Load (lbf) | Tensile Strength (psi) | Comments | Tested By | | 1 | 1 | 93930 | 94000 | Ok Necking | Kleinfelder | | 1 | 1 | 94420 | 94500 | Ok Necking | Kleinfelder | | 1 | 1 | 94590 | 94500 | Ok Necking | Kleinfelder | | 1 | 1 | 94660 | 94500 | Ok Necking | Kleinfelder |
| |
|
Temperature
|
0 f
|
|
UTM
|
NA
|
