Sample Record for 2022-03-15-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214337 DEA: 080E33U4 EFIS: 0817000075
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-115-R7.3/R10.0
Work Description: ADD WB AUX & EB DECEL LANES, WIDEN I15 SW CONNECT,RAMPS/BRDG
Location Description: SAN BERNARDINO COUNTY IN ONTARIO FROM 0.2 MILE WEST OF CUCAMONGA CREEK BRIDGE TO MILLIKEN AVENUE
Contractor Name: Ames Construction
Contractor Address: 391 North Main Street, Suite 302, Corona, CA 92880
Resident Engineer: Denise Sostrom Structure Rep.: Matt Bruce
Sample Information
DIME Sample ID: 2022-03-15-1
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 Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 03/15/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/15/2022
The quantity of what the sample constitutes: 3 anchor bolts
A brief description of the sample: 2-1/2 Anchor bolt
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Madden Bolt
Material Information
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A529
Threaded Bar Grade: 55
Threaded Bar Type: Plain
Rebar Size:
Nut Specification for Threaded Bar: A563
System Manufacturer: Dyson
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: ASTM A153 galvanized
Bar Heat Number(s): 58050393
Nut Heat Number(s): 20734310
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
Test Results
