Project Information

Project ID: 994525 DEA: 031H9904 EFIS: 0317000043 QA Service Level: 1

DIST-CO-RTE-PM: 03-PLA,NEV-80-68.3/69.7,0.0/R2.7

Work Description: RDWY EXC, PLACE HMA & JPCP, SLAB REPLACEMENT & POLYESTER CONC OVERLAY.

Location Description: PLACER AND NEVADA COUNTIES NEAR KINGVALE FROM 0.3 MILE WEST OF TROY UNDERCROSSING TO 0.2 MILE EAST OF SODA SPRINGS OVERCROSSING

Contractor Name: A. TEICHERT & SON INC DBA TEICHERT CONSTRUCTION

Contractor Address: 4401 Duluth Avenue, Rocklin, CA 95765

Resident Engineer: Randie Babbini Structure Rep.: Carl Anderson

Sample Information

DIME Sample ID: 2024-06-26-5

TL Number from the TL Form:

Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office

Sample Organization Contact: (916) 2058871

Type of Sample: Quality Assurance

Type of Material: SMTL TM7 - Epoxy Coated Rebar

Sample Taken Date: 06/26/2024

Date that the sample was received by the laboratory/organization performing the testing: 06/26/2024

The quantity of what the sample constitutes: 75-Shipment

A brief description of the sample: Green Epoxy #5 Rebar

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Camblin Steel

Material Information

Rebar Heat Number(s): 087224

Rebar Epoxy Batch Number(s): CH3553SY

Rebar Coating Specification: ASTM A775

Rebar Size (#): #5

Rebar Coating Color: Green

Rebar Manufacturer: Cascade Steel

Rebar Coater: Western Coating Ogden UT

Rebar Powder Manufacturer: Sherwin Williams

Release Number:

Quality Assurance Code:

Test Results

Test 1 of 2

DIME Test ID: 2024-06-26-5-1

Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Epoxy Coating)

Verified Date: 07/09/2024

Date Tested: 07/02/2024

Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory

Organization Address: 5900 Folsom Boulevard,

Organization City: Sacramento

Organization State: CA

Organization Zipcode: 95819

Organization Email: joshua.moore@dot.ca.gov

Organization Phone: (530) 329-6527

General Comments for this Test:

Test Result Compliance: complies

Additional Comments When Verified:

First Bar Mean	10.03
Second Bar Mean	9.3
Lower spec. limit LSL	7
Upper spec. limit USL	12
Bar # for First Bar	1
Bar # for Second Bar	2
Total mean value	9.66
Total number of values less than LSL	no data
Total number of values greater than USL	no data

Test 2 of 2

DIME Test ID: 2024-06-26-5-2

Test Method: ASTM A775-19: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)