Sample Record for 2021-02-03-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213653 DEA: 044G8204 EFIS: 0413000049
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-10.6/10.8
Work Description: REPLACE SAN RAFAEL HARBOR BRIDGE (ABC)
Location Description: MARIN COUTY, IN SAN RAFAEL, FROM ROUTE 101 NORTHBOUND OFF-RAMP TO 2ND STREET
Contractor Name: Gordon N. Ball
Contractor Address: 333 Camille Ave., Alamo, CA 94507
Resident Engineer: Dawit Habteselassie Structure Rep.: Long N Ly
Sample Information
DIME Sample ID: 2021-02-03-5
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 Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 02/03/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4 Headed Bars from lot 1
A brief description of the sample: #6 button headed bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Camblin Steel Service
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 6019603
Head Manufacturer Lot Number(s): 13G2
Rebar Size: #6
Headed Bar Model Name: BNX Buttonhead
Size of Head: Full Size - 9x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: CMC Steel California
Head Manufacturer: Bar Splice Products
Head Fabricator: Bar Splice
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
