Sample Record for 2023-01-10-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215188 DEA: 080F5434 EFIS: 0817000239 Permit Numbers: 0823NMC0369
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-I-15,SR-91-6.1-7.6
Work Description: I-15 ELC: 15/91 Express Lanes Connector Project (ELC)
Location Description: Junction of I-15 and SR-91 in Corona, CA
Contractor Name: Myers-Rados Joint Venture
Contractor Address: 629 N. Main Street, Suite C3, Corona, CA 92878
Resident Engineer: Roy Fisher Structure Rep.: Alhakem Alina
Sample Information
DIME Sample ID: 2023-01-10-6
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 - Headed Bars
Sample Taken Date: 01/10/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 45
A brief description of the sample: #11 HRC 120
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 1075
Head Manufacturer Lot Number(s): 1
Rebar Size: #11
Headed Bar Model Name: HRC 120
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: HRC Fountain Valley
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
Test Results
