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Sample Record for 2021-10-22-4

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Project Information

Project ID: 213750 DEA: 120K0224 EFIS: 1214000097 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-14.5/17.1
Work Description: South County Improvement Project (Phase 2 - Oso/Alicia) CONST BRIDGES, RW, SW, HMA PVMT, JPCP, DRAINAGE, AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN MISSION VIEJO AND LAGUNA HILLS FROM 0.7 MILE SOUTH OF OSO PARKWAY OVERCROSSING TO 0.3 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING
Contractor Name: Flatiron West, Inc
Contractor Address: 1770 La Costa Meadows Drive, San Marcos, California 92078
Resident Engineer: Steven Kim Structure Rep.: Sara Soleimani

Sample Information

DIME Sample ID: 2021-10-22-4
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: Verification
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 10/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/26/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: Epoxy Coated Dowel Basket
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway - Simplex

Material Information

Dowel Metal Heat Number: 201860
Dowel Epoxy Batch Number: 3CH2112012
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: American Highway Simplex
Dowel Coater: American Highway Simplex
Release Number:
Quality Assurance Code:
Rebar Size (#): #12
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-10-22-4-1
Test Method: ASTM A775-07b-re14: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)
Verified Date: 10/28/2021
Date Tested: 10/27/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 3
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass
Bend Test Pass/Fail NA

Test 2 of 2

DIME Test ID: 2021-10-22-4-2
Test Method: ASTM A775-07b-re14: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Epoxy Coating)
Verified Date: 10/28/2021
Date Tested: 10/27/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 14.52
Second Bar Mean 14.53
Lower spec. limit LSL 7
Upper spec. limit USL 40
Bar # for First Bar 1
Bar # for Second Bar 2
Total mean value 14.53
Total number of values less than LSL no data
Total number of values greater than USL no data