Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215113 DEA: 021J2404 EFIS: 0220000048
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA,VAR-273,Var-Var
Work Description: PSPS Streetlight Backing plates-Steel Cantilever structure for solar panels
Location Description:
Contractor Name: CAL ELECTRO, INC.
Contractor Address: 3710 Electro Way, Redding, CA 96002
Resident Engineer: Michael Zdenek Structure Rep.: Unknown
DIME Sample ID: 2020-09-28-10
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 09/28/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 160
A brief description of the sample: 1/2" Domestic hot dipped galvanized ASTM F436 type 1 hardened washer.
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Portland Bolt
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A449
Threaded Bar Grade: 36
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: NA
System Manufacturer: NA
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: ASTM A123 galvanized
Bar Heat Number(s):
Nut Heat Number(s):
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
