Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994780 DEA: 070W3304 EFIS: 0721000265
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-19.5/29.5
Work Description: LOS ANGELES COUNTY FROM EVERGREEN AVENUE PEDESTRIAN OVERCROSSING IN LOS ANGELES TO VALLEY BOULEVARD UNDERCROSSING IN EL MONTE
Location Description: DIGOUTS, SLURRY SEAL, COLD PLANE OVERLAY,
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Sushilkumar Chaudhari Structure Rep.: Unknown
DIME Sample ID: 2023-06-08-8
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 Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 06/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/08/2023
The quantity of what the sample constitutes: 4 oz of AkzoNobel RB-600 Epoxy
A brief description of the sample: Epoxy Sample
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Company Santa Fe Springs, CA.
Dowel Metal Heat Number: n a
Dowel Epoxy Batch Number: YJ78400NA
Dowel Coating Specification: ASTM A775
Dowel Size: 1.25 in
Dowel Coating Color: Green
Dowel Manufacturer:
Dowel Coater: AkzoNobel Coatings
Release Number:
Quality Assurance Code:
Rebar Size (#):
