Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214579 DEA: 010B0904 EFIS: 0100020444
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: Panther Creek & Hunter Creek Bridges
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis
DIME Sample ID: 2021-02-05-4
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 - Welded Hoops
Sample Taken Date: 02/05/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/05/2021
The quantity of what the sample constitutes: 40 hoops
A brief description of the sample: #6 rebar 2'-6" dia. hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TNT Rebar Company
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 3500015250
Hoop Manufacturer Lot Number(s): Lots 1-10
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 2'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: TNT Rebar Company
Coating Standards: Uncoated
Weld Type: Flash Welded
