Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88887 DEA: PC-Barrier-STOCK EFIS: PC-Barrier-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for precast barrier rail stock material.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-10-04-31
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Authorization
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 10/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/06/2022
The quantity of what the sample constitutes: 5
A brief description of the sample: HRC 500/510 #18
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: HRC
Intermediate Assembler or Fabricator:
Rebar Size: #18
Coupler Model: HRC 500/510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 74122078 / MM20102405
Rebar Heat Number(s): 9000571
Rebar Size 2 : 18
Coupler Unique ID: Not on AML
