Sample Record
Owner Lab
- CT HQ - QASI Bay Area Field Office
DIME Sample ID 2025-07-14-2
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Project Information
| Project Identifiers | Project ID: 994816 DEA: 010E11U4 EFIS: 0123000069 |
|---|---|
| DIST-CO-RTE-PM | 01-MEN-1-31.1/31.6 |
| Award Date | 11/15/2023 |
| Closeout Date | Not set |
| Work Description | STRUCTURAL CONC BRIDGE, TEMP BRIDGE AND BAR REINFORCING STEEL. |
| Location Description | MENDOCINO COUNTY NEAR ELK FROM 0.2 MILE SOUTH OF ELK CREEK BRIDGE TO 0.2 MILE NORTH OF ELK CREEK BRIDGE |
| QA Service Level | 1 (Verified on 05/22/2023) |
Sample Information
| Sample Taken Date | 07/14/2025 | Sample Unique Key | 2 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | No | Date that the sample was received by the laboratory/organization performing the testing | 07/16/2025 |
| Sample type | Quality Assurance | A brief description of the sample | Couplers with #11 bar, Grade 80 |
| The quantity of what the sample constitutes | 1 lot of 48 | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Stacey | Last name of sampler or witnessed by | Davis |
| Title of sampler | QAI | Telephone number of sampler | 5624806984 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | CMC Tracy | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | S86-024-25 | Structure unique identifier | 10-0312 |
| Structure name | Elk Creek Bridge | Bid Item | Not set |
Material Information
| Material Type | SMTL TM5 - Couplers | Production or Authorization Testing | Production Testing |
|---|---|---|---|
| Service or Ultimate | Ultimate | Material Standard Code | ASTM A706 |
| Material Grade | 80 | Rebar Manufacturer | CMC Mesa |
| Coupler Manufacturer | HRC Gerdau | Intermediate Assembler or Fabricator | CMC Tracy |
| Rebar Size | #11 | Coupler Model | Extender 500 |
| Coating Standards | Uncoated | Shape of Rebar | Straight |
| Rebar Hoop Diameter | Rebar Hoop Fabricator | ||
| Coupler Component Heat/Lot Number(s) | 74126669 | Rebar Heat Number(s) | 9004339 |
| Rebar Size 2 | Coupler Unique ID | TF-17-02 |
Submitted Tests
Test File Attachments
DIME Test ID: 2025-07-14-2-1 CTM 670-December 2013 (Verified)