Sample Record

DIME Sample ID 2021-07-01-3

Project Information

Project IdentifiersProject ID: 215424
DEA: 024G4404
EFIS: 0214000013
DIST-CO-RTE-PM02-SIS-3-38.0/38.6
Award Date04/05/2021
Closeout Date08/14/2023
Work DescriptionBRIDGE REPLACEMENT
Location DescriptionSISKIYOU COUNTY ABOUT 6 MILES NORTH OF FORT JONES FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF LOWER MOFFETT CREEK ROAD
QA Service Level1 (Verified on 01/19/2021)

Owner Lab

  • CT HQ - QASI Sacramento Field Office

Sample Information

Sample Taken Date07/01/2021 Sample Unique Key3
Date that the sample was received by the laboratory/organization performing the testingNot set Sample typeQuality Assurance
A brief description of the sample#5 epoxy coated formsaver couplers The quantity of what the sample constitutes2 lots
From where was the sample collectedFabricator First name of sampler or witnessed byJane
Last name of sampler or witnessed byLillard Title of samplerCALTRANS QA INSPECTOR
Telephone number of sampler916-291-8042 Laboratory sample identification
Linked DIME Sample ID The fabricator/manufacturer/facility nameCon-Fab California, LLC
Transportation Laboratory (TL) Number Inspector Lot Number from the Transportation Laboratory (TL) FormS52-027-21
Structure unique identifier Structure nameExterior girders M1, M3
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 ManufacturerErico Lenton Intermediate Assembler or FabricatorConFab Lathrop
Rebar Size#5 Coupler ModelELC16FS2
Coating StandardsASTM A775 epoxy Shape of RebarStraight
Rebar Hoop Diameter Rebar Hoop Fabricator
Coupler Component Heat/Lot Number(s)Erico lot A1289 and 9830 Rebar Heat Number(s)3600019380
Rebar Size 2 5 Coupler Unique IDNot set

Submitted Tests

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