Sample Record for 2022-03-16-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214663 DEA: 081F7304 EFIS: 0815000034
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-2.7
Work Description: REPLACE CONCRETE BRIDGE, PLACE CONCRETE PCPS GIRDERS AND HMA.
Location Description: SAN BERNARDINO COUNTY IN COLTON AT WASHINGTON STREET OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Shaine Shahidi Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-03-16-4
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 - Couplers
Sample Taken Date: 03/16/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/16/2022
The quantity of what the sample constitutes: 4 samples from Lot # 1
A brief description of the sample: #7 Rebar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar Placers
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A615
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: Bar Splice Products
Intermediate Assembler or Fabricator:
Rebar Size: #7
Coupler Model: Double Barrel Zap Screwlok
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 0344
Rebar Heat Number(s): 65033264
Rebar Size 2 :
Coupler Unique ID:
Test Results
