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: 2026-07-02-2
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 Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 07/02/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/06/2026
The quantity of what the sample constitutes: 216
A brief description of the sample: #9 Threaded Bar, Washer, Hex Nut
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Z Systems, Inc.
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size: #9
Nut Specification for Threaded Bar: ASTM A519
System Manufacturer: BCI Solutions
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: Uncoated
Bar Heat Number(s): 58070082/03
Nut Heat Number(s): 04206
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
