Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002064 DEA: 010J8014 EFIS: 0120000032
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-299-R8/R9.2
Work Description: Blue Lake Realignment & SPGA Wall
Location Description: Blue Lake Landslide Repair
Contractor Name: STEVE MANNING CONSTRUCTION, INC
Contractor Address: 5211 Churn Creek Road, Redding, CA 96002
Resident Engineer: Ethan Retherford Structure Rep.: Adlai Evans
DIME Sample ID: 2026-06-25-15
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2026
The quantity of what the sample constitutes: #9 Gr.75 Threaded Bar, Coupler, Nut, washers
A brief description of the sample: #9 Gr.75 Threaded Bar, Coupler, Nut, washers
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Z systems
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A897 GR. 75
System Manufacturer: z systems
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: Uncoated
Bar Heat Number(s): A216934
Nut Heat Number(s): K134
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s): 5394158
Coupler Grade: 75
