Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212900 DEA: 051G6804 EFIS: 0515000063
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-101-16.2-20.3
Work Description: US 101 PISMO CONGESTION RELIEF PROJECT
Location Description: IN SAN LUIS OBISPO COUNTY IN PSMO BEACH FROM PISMO OVERHEAD TO 0.5 MILE NORTH OF SHELL BEACH ROAD UC
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 351 North Blosser Road, Santa Maria, CA 93458
Resident Engineer: Philip Gaston Structure Rep.: Sal Heredia
DIME Sample ID: 2026-08-24-1
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 - Welded Hoops
Sample Taken Date: 08/24/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4 of 96
A brief description of the sample: Resistance welded hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar San Bernadino
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4160266
Hoop Manufacturer Lot Number(s): Lot 1
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 3'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Arizona
Welding Company: CMC Rebar San Bernardino
Coating Standards: Uncoated
Weld Type: Flash Welded
