Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001723 DEA: 050N7064 EFIS: 0524000077
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-10.9/12.3
Work Description: SB 101 - Segment 4E North - Cabrillo
Location Description:
Contractor Name: Granite Construction
Contractor Address: P.O. Box. 6744, Santa Barbara, CA
Resident Engineer: Tristan Gebhart Structure Rep.: Josh Madrigal
DIME Sample ID: 2026-08-17-61
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: 08/17/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/25/2026
The quantity of what the sample constitutes: NA
A brief description of the sample: NA
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: 60
Rebar Manufacturer: NA
Coupler Manufacturer: NA
Intermediate Assembler or Fabricator:
Rebar Size: #8
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): NA
Rebar Size 2 :
Coupler Unique ID: TP-17-03
