Sample Record for 2024-07-02-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994751 DEA: 010C5004 EFIS: 0112000292
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-11.3/34.6
Work Description: Project Name: Bridge Rail Replacement - 3 Bridges
Location Description: Hely Creek, Little Larabee Creek and Butte Creek Bridge.
Contractor Name: Mercer-Fraser Company
Contractor Address: 200 Dinsmore Dr, Fortuna, CA 95540
Resident Engineer: Joaquin Rodriguez Structure Rep.: Shantanu Nalawade
Sample Information
DIME Sample ID: 2024-07-02-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 07/02/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 40
A brief description of the sample: x
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Steel Group, Napa, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 3500032332
Head Manufacturer Lot Number(s): 3500032332
Rebar Size: #11
Headed Bar Model Name: HRC T Heads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: Pacific Steel Group Napa
Head Fabricator: Pacific Steel Group Napa
Material Standard Code: ASTM A706
Headed Bar Unique ID: 4FG-17-01
Test Results
