Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002077 DEA: 033H5904 EFIS: 0318000017
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-R26.3/R55.2
Work Description:
Location Description:
Contractor Name: Flatiron Dragados/Teichert
Contractor Address: 555 S Auburn St, Colfax, CA 95713
Resident Engineer: John Ruzic Structure Rep.: Carl Anderson
DIME Sample ID: 2026-07-27-57
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 - Couplers
Sample Taken Date: 07/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/03/2026
The quantity of what the sample constitutes: 4
A brief description of the sample: #5 Coupler Gr. 80
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 80
Rebar Manufacturer: CMC
Coupler Manufacturer: NA
Intermediate Assembler or Fabricator:
Rebar Size: #5
Coupler Model: NA
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): NA
Rebar Heat Number(s): 4157182
Rebar Size 2 :
Coupler Unique ID: SB-17-02
DIME Test ID: 2026-07-27-57-1
Test Method: CTM 670-December 2013: Method of Tests for Mechanical and Welded Reinforcing Steel Splices (Tensile Slip)
Verified Date: 08/18/2026
Date Tested: 08/10/2026
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:
|
Number of Samples
|
4
|
| Sample | Mfg. Lot Number(s) | Size | Area (sqin) | Slip (inch) | Peak Load (lbf) | Peak Stress (psi) | Comments | Tested By | | 1 | 4157182 | 5 | 0.31 | 0.0010 | 36210 | 116806 | NA | Atlas | | 2 | 4157182 | 5 | 0.31 | 0 | 36110 | 116484 | NA | Atlas | | 3 | 4157182 | 5 | 0.31 | 0 | 35110 | 113258 | NA | Atlas | | 4 | 4157182 | 5 | 0.31 | 0 | 36200 | 116774 | NA | Atlas |
| |
|
Temperature
|
0 f
|
|
UTM
|
NA
|
|
Halo ID
|
NA
|
