Sample Record for 2026-06-25-22
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000607 DEA: 081K6904 EFIS: 0819000090
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-5.7/11.8
Work Description: ROCK EXCAVATION, HMA (TYPE A), RHMA-G, AND CABLE NET DRAPERY SYSTEM.
Location Description: RIVERSIDE COUNTY IN AND NEAR LAKE ELSINORE FROM MONTE VISTA STREET TO GRAND AVENUE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Fereydoon Alipanah Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-06-25-22
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: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/02/2026
The quantity of what the sample constitutes: 4
A brief description of the sample: R71 1-3/8” 150 ksi Epoxy Coated All-Thread Bar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Eng
Material Information
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type: Plain
Rebar Size:
Nut Specification for Threaded Bar: ASTM A29
System Manufacturer: Williams Form Eng
Epoxy Coating Color: Purple
Threaded Bar Application: Soil Nail
Coating Standards: ASTM A934 epoxy
Bar Heat Number(s): 1000228730
Nut Heat Number(s): 79013697
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s): 256637
Coupler Grade: 1045
Test Results
