Sample Record for 2026-06-19-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2026-06-19-10
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 06/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2025
The quantity of what the sample constitutes: x
A brief description of the sample: #8 ZAP SCREWLOK SL Coupler
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: x
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A615
Material Grade: 60
Rebar Manufacturer: Cascade
Coupler Manufacturer: Barsplice and Nucor
Intermediate Assembler or Fabricator:
Rebar Size: #8
Coupler Model: Zap Screwlok Type 2
Coating Standards: ASTM A934 epoxy
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 74134732
Rebar Heat Number(s): 1201060250
Rebar Size 2 :
Coupler Unique ID: SL-17-03
Test Results
