Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993235 DEA: 051H4504 EFIS: 0516000075
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-154-R31.8/R32.1
Work Description: CONSTRUCT CIDH CONCRETE PILES AND STRUCTURAL CONCRETE BRIDGE.
Location Description: SANTA BARBARA COUNTY IN AND NEAR SANTA BARBARA FROM PRIMAVERA ROAD UNDERCROSSING TO LA COLINA ROAD UNDERCROSSING
Contractor Name: CA Rasmussen
Contractor Address: 28548 LIVINGSTON AVENUE, VALENICA CA 91355
Resident Engineer: Jeffery Finn Structure Rep.: Emiliano Berntsen
DIME Sample ID: 2022-04-19-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 04/19/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2022
The quantity of what the sample constitutes: 48
A brief description of the sample: Lenton/Erico Headed Bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martinez steel
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 024822
Head Manufacturer Lot Number(s): 1
Rebar Size: #11
Headed Bar Model Name: Lu36Mt12
Size of Head: Full Size - 9x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: Cascade Steel
Head Manufacturer: Erico
Head Fabricator: Lenton
Material Standard Code: ASTM A706
Headed Bar Unique ID:
