Sample Record for 2023-02-13-30
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993279 DEA: 010E0904 EFIS: 0113000123
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20-33.3/34.4
Work Description: CONSTRUCT NEW BRIDGE, REMOVE TWO BRIDGES, EARTHWORK AND PAVING. (Bridge No. 10-0310)
Location Description: MENDOCINO COUNTY NEAR UKIAH FROM 0.3 MILE WEST OF RUSSIAN RIVER BRIDGE AND OVERHEAD TO 0.3 MILE EAST OF COUNTY ROAD 144
Contractor Name: Myers & Sons Construction LLC
Contractor Address: 4600 Northgate Blvd, Suite 100, Sacramento, CA 95838
Resident Engineer: Geoffrey Wright Structure Rep.: Kari Forbes
Sample Information
DIME Sample ID: 2023-02-13-30
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 Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 02/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/13/2023
The quantity of what the sample constitutes: 19
A brief description of the sample: #10 Headed reinforcement
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4121487
Head Manufacturer Lot Number(s): 2
Rebar Size: #10
Headed Bar Model Name: 555
Size of Head: Reduced Size - 4x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: CMC Rebar
Head Manufacturer: CMC Rebar
Head Fabricator: CMC Rebar
Material Standard Code: ASTM A706
Headed Bar Unique ID: 4FG-17-01
Test Results
