Sample Record for 2024-06-13-9
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994588 DEA: 081H3904 EFIS: 0817000032
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R20.5/R21.6,R25.5/R30.7
Work Description: CONSTRUCT BUILDING, ROADWAY EXC, JPCP, AND TEMPORARY BARRIER SYSTEM.
Location Description: SAN BERNARDINO COUNTY FROM 0.6 MILE NORTH OF CLEGHORN ROAD UNDERCROSSING TO 0.5 MILE SOUTH OF ROUTE 138 AND FROM 0.5 MILE SOUTH OF TRUCK SAFETY CHECK AREA TO 0.4 MILE NORTH OF OAK HILL ROAD OVERCROSSING
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 8555 BANANA AVE, FONTANA, CA 92335
Resident Engineer: Mauricio Santa Cruz Structure Rep.: Oluwatayo (Tayo) Ogeyemi
Sample Information
DIME Sample ID: 2024-06-13-9
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 Rebar
Sample Taken Date: 06/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/21/2024
The quantity of what the sample constitutes: 429 EA
A brief description of the sample: #6 x 10" bent bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway - Simplex
Material Information
Rebar Heat Number(s): 1202059427
Rebar Epoxy Batch Number(s): CH2613TV, CH0943FR
Rebar Coating Specification: ASTM A934
Rebar Size (#): #6
Rebar Coating Color: Purple
Rebar Manufacturer: Nucor
Rebar Coater: American Highway Simplex
Rebar Powder Manufacturer: Sherwin Williams
Release Number:
Quality Assurance Code:
Test Results
