Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2021-05-27-14

Project Information

Project IdentifiersProject ID: 214355
DEA: 120K0214
EFIS: 1214000096
DIST-CO-RTE-PM12-ORA-5-12.4/14.5
Award Date12/20/2019
Closeout Date10/02/2025
Work DescriptionSouth County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location DescriptionORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
QA Service Level1 (Verified on 10/31/2019)

Sample Information

Sample Taken Date05/27/2021 Sample Unique Key14
Date that the sample was received by the laboratory/organization performing the testingNot set Sample typeQuality Control
A brief description of the sampleDayton Superior D101A Dowel Bar (SF-17-01) The quantity of what the sample constitutes(16) #5 D101A Dowel Bar (D-B)
From where was the sample collectedFabricator First name of sampler or witnessed byRigoberto
Last name of sampler or witnessed byMarin Title of samplerAMR
Telephone number of sampler951-500-0685 Laboratory sample identification
Linked DIME Sample ID The fabricator/manufacturer/facility nameCoreslab Structures L A Inc
Transportation Laboratory (TL) Number Inspector Lot Number from the Transportation Laboratory (TL) FormL133-064-21
Structure unique identifier Structure name
Bid ItemNot set

Material Information

Material TypeSMTL TM5 - Couplers Production or Authorization TestingProduction Testing
Service or UltimateService Material Standard CodeASTM A706
Material Grade60 Rebar ManufacturerNucor
Coupler ManufacturerDayton Superior Intermediate Assembler or FabricatorCoreslab Structures L A Inc
Rebar Size#5 Coupler ModelSF-17-01
Coating StandardsUncoated Shape of RebarStraight
Rebar Hoop DiameterNA Rebar Hoop FabricatorNA
Coupler Component Heat/Lot Number(s)128314 Rebar Heat Number(s)3500014854
Rebar Size 2 5 Coupler Unique IDNot set

Submitted Tests

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