Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215456 DEA: 07293604 EFIS: 0713000238
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-14.3/15.8
Work Description: CONSTRUCT AUXILIARY LANE AND WIDEN ON AND OFF RAMPS.
Location Description: LOS ANGELES COUNTY IN TORRANCE BETWEEN WESTERN AVENUE UNDERCROSSING AND WEST 182ND STREET
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 CUSHING SUITE 200, IRVINE CA 92618
Resident Engineer: Samuel Gallardo Structure Rep.: James Holloway
DIME Sample ID: 2022-04-12-2
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 04/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2022
The quantity of what the sample constitutes: 3 sets of #5 Hoops from lots 1-117
A brief description of the sample: 2 ft Dia Hoops ,#5 A706 rebar Gr 60
From where was the sample collected: Fabricator
Laboratory sample identification: QC - 1 -11, total 11 lots
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 1100028176
Hoop Manufacturer Lot Number(s): 1-11- QC
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #5
Diameter of Hoop: 2'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
