Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995495 DEA: 101C2704 EFIS: 1014000097
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-5-27.1
Work Description: REPLACE SAFETY ROADSIDE REST AREA.
Location Description: STATE HIGHWAY IN STANISLAUS COUNTY ABOUT 1.0 MILE SOUTH OF SAN JOAQUIN COUNTY LINE AT THE WESTLEY SAFETY ROADSIDE REST AREA
Contractor Name: TSI ENGINEERING, INC.
Contractor Address: 4600 Roseville Road, Suite140, North Highland, CA 95660
Resident Engineer: Zubair Anwar Structure Rep.: Sai Kasaraneni
DIME Sample ID: 2024-09-10-10
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 - Welded Hoops
Sample Taken Date: 09/10/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1296
A brief description of the sample: #4 2'-0" Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4141569
Hoop Manufacturer Lot Number(s): #1-9
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #4
Diameter of Hoop: 2'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
