Sample Record for 2023-09-22-5
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete
Sample Information
DIME Sample ID: 2023-09-22-5
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: 09/22/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2023
The quantity of what the sample constitutes: 8 headed bars
A brief description of the sample: #10 HRC 120 T Heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley
Material Information
Production or Authorization Testing: Authorization Testing
Rebar Heat Number(s): 4132288
Head Manufacturer Lot Number(s): 100012049345
Rebar Size: #10
Headed Bar Model Name: HRC 120 T Head
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: Nucor Utah Cold Finish Division
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
Test Results
