Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993253 DEA: 033F0604 EFIS: 0312000052
QA Service Level: 1
DIST-CO-RTE-PM: 03-GLE-162-76.3/78.6
Work Description:
Location Description:
Contractor Name: GOLDEN STATE BRIDGE
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Dustin Watts Structure Rep.: Matt Crete
DIME Sample ID: 2022-12-29-4
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 - Welded Hoops
Sample Taken Date: 12/29/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1196
A brief description of the sample: #8 X 4'-0.5" Ultimate Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4123933
Hoop Manufacturer Lot Number(s): 61-68
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #8
Diameter of Hoop: 4'-0.5"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Arizona
Welding Company: CMC Rebar San Bernardino
Coating Standards: Uncoated
Weld Type: Flash Welded
