Sample Record for 2024-06-18-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215664 DEA: 070W0304 EFIS: 0720000257
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN,LA-126-R13.2/R34.6,R0.0/R4.1
Work Description: REPLACE AC SURFACING, PLACE SLURRY SEAL AND PAVEMENT MARKING.
Location Description: VENTURA AND LOS ANGELES COUNTIES NEAR SANTA PAULA AND SANTA CLARITA FROM HALLOCK DRIVE TO CASTAIC CREEK BRIDGE
Contractor Name: C. A. RASMUSSEN INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2024-06-18-1
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: Recertification
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 06/18/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 8
A brief description of the sample: OCM OS Splice Clips #8
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Rouch Rebar Inc.
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Cascade
Coupler Manufacturer: Barsplice Dextra America
Intermediate Assembler or Fabricator:
Rebar Size: #6
Coupler Model: Bar Lock D250sca
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 80822121
Rebar Heat Number(s): 452323,453423
Rebar Size 2 :
Coupler Unique ID: SL-17-01
Test Results
