Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994084 DEA: 060U8804 EFIS: 0616000074
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-26.3/27.6
Work Description: CONSTRUCT A NEW INTERCHANGE AT COMMERCIAL AVENUE NOW CALLED INTERNATIONAL AGRI-CENTER WAY
Location Description: ON STATE ROUTE 99
Contractor Name: SECURITY PAVING COMPANY INC
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Alberto Lopez Structure Rep.: Vicente Sanchez
DIME Sample ID: 2023-12-08-4
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 - Welded Hoops
Sample Taken Date: 12/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/13/2023
The quantity of what the sample constitutes: 186
A brief description of the sample: #9 5'-2" Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 1202054150
Hoop Manufacturer Lot Number(s): 1-2
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #9
Diameter of Hoop: 5'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: NUCOR
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
