Sample Record for 2022-08-26-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212498 DEA: 021H5204 EFIS: 0217000009
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3,263-48.5/49.7 - 49.41
Work Description: Roadway Rehabilitation
Location Description: 02-Sis-3, 263-R46.8/R48.0, 49.07/49.41
Contractor Name: Myers-Shea JV
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Austin Henry Structure Rep.: Nicolas Jimenez
Sample Information
DIME Sample ID: 2022-08-26-10
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 08/26/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 204 each Uleg ST 28"
A brief description of the sample: Tie bar assemblies
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway
Material Information
Rebar Heat Number(s): B-1202042220 W-12021041685
Rebar Epoxy Batch Number(s): ch1032BV CCL-3ch2149022
Rebar Coating Specification: ASTM A934
Rebar Size (#): 1.25" x 18"
Rebar Coating Color: Purple
Rebar Manufacturer: Nucor
Rebar Coater: American Highway
Rebar Powder Manufacturer: Sherwin WIlliams
Release Number:
Quality Assurance Code:
Test Results
