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: 2026-09-23-9
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 TM7 - Epoxy Coated Rebar
Sample Taken Date: 09/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2026
The quantity of what the sample constitutes: 3 bars audit
A brief description of the sample: ASTM 706 #5 Rebar grade 60
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar Brighton
Rebar Heat Number(s): 4161657
Rebar Epoxy Batch Number(s): CH72086NA
Rebar Coating Specification: ASTM A775
Rebar Size (#): 5
Rebar Coating Color: Green
Rebar Manufacturer: CMC Rebar Arizona
Rebar Coater: CMR Rebar Brighton CO
Rebar Powder Manufacturer: AkzoNobel
Release Number: HKF30R-F
Quality Assurance Code:
