Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210673 DEA: 042640F4 EFIS: 0400020132 COOP: 042308A3
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON--
Work Description:
Location Description:
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Gina Choi Structure Rep.: Brian Beaudoin
DIME Sample ID: 2021-09-23-7
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: 09/23/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4 Hoops
A brief description of the sample: #8 x 5'-2" dia.
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TNT Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 1201033913
Hoop Manufacturer Lot Number(s): Lot 3
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #8
Diameter of Hoop: 5'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: TNT Rebar Company
Coating Standards: Uncoated
Weld Type: Flash Welded
