Sample Record for 2023-04-17-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993815 DEA: 081C0814 EFIS: 0816000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R60.7/R74.3
Work Description: I-10 PAVEMENT REHABILITATION (SEGMENT 1) PROJECT
Location Description: Coachella
Contractor Name: COFFMAN SPECIALTIES, INC
Contractor Address: 4375 JUTLAND DRIVE STE 260, SAN DIEGO CA 92117
Resident Engineer: Michael Sergah Structure Rep.: Al Alina
Sample Information
DIME Sample ID: 2023-04-17-3
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: 04/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/20/2023
The quantity of what the sample constitutes: 408
A brief description of the sample: #8 HRC T-120
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 6039245
Head Manufacturer Lot Number(s): 1-3
Rebar Size: #8
Headed Bar Model Name: HRC 120
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Square
Rebar Manufacturer: CMC Rebar
Head Manufacturer: HRC Fountain Valley
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
Test Results
