Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994418 DEA: 040J5504 EFIS: 0414000012
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-84-17.2/17.2
Work Description: REPLACE BRIDGE, WIDEN ROADWAY, & CONSTRUCT SIDEWALKS.
Location Description: ALAMEDA COUNTY AT SUNOL FROM SILVER SPRING ROAD UNDERPASS TO PLEASANTON SUNOL ROAD
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407
Resident Engineer: Scott Sowko Structure Rep.: Jordan Jarosz
DIME Sample ID: 2026-10-05-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Verification
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 10/05/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 40000 lbs
A brief description of the sample: 2ea 6.5' W80 S1 bars
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Nucor Rebar Fabrication Lathrop
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Rebar Heat Number(s): 4100001544
Hoop Manufacturer Lot Number(s): xxxxxx
Material Standard Code: ASTM A706
Material Grade: 80
Rebar Size: #10
Diameter of Hoop: 60'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: Nucor
Coating Standards: Uncoated
Weld Type: Flash Welded
