Sample Record for 2024-04-17-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995498 DEA: 072XL104 EFIS: 0724000158
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-14.23
Work Description: LA-10, Construct temporary structural shoring - Column Casings Repair Work
Location Description: I-10 at Olympic Blvd
Contractor Name: SECURITY PAVING COMPANY INC
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Sepand Minovi Structure Rep.: Suh Kwangsuk
Sample Information
DIME Sample ID: 2024-04-17-3
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 - Couplers
Sample Taken Date: 04/17/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1220 couplers/ 7 lots
A brief description of the sample: #4 Double Barrel Zap Screwlock Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Security Paving Company
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator:
Rebar Size: #4
Coupler Model: Double Barrel Zap Screwlok
Coating Standards: Uncoated
Shape of Rebar: Hoop
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 04DBZA
Rebar Heat Number(s): 4138494
Rebar Size 2 :
Coupler Unique ID: SB-17-02
Test Results
