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: 2026-08-04-5
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 Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 08/04/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 48 pcs.
A brief description of the sample: #11 rebar with HRC 120 T-Head
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corporation (HRC)
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 9013302
Head Manufacturer Lot Number(s): 100013306541
Rebar Size: #11
Headed Bar Model Name: HRC Type 120
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: Nucor
Head Fabricator: Headed Reinforcement Corp
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
