Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2021-09-13-2
Sample is locked from editing. info
Project Information
| Project Identifiers | Project ID: 213099 DEA: 041A6614 EFIS: 0415000291 COOP: 042683A1 |
|---|---|
| DIST-CO-RTE-PM | 04-MRN-101-8.4 |
| Award Date | 11/30/2020 |
| Closeout Date | 12/12/2023 |
| Work Description | CONSTRUCTION ON STATE HIGHWAY IN MARIN COUNTY IN LARKSPUR |
| Location Description | Not set |
| QA Service Level | 1 (Verified on 11/06/2020) |
Sample Information
| Sample Taken Date | 09/13/2021 | Sample Unique Key | 2 |
|---|---|---|---|
| Will the laboratory/organization for which you are a member perform testing on this material sample? | Yes | Date that the sample was received by the laboratory/organization performing the testing | 10/01/2021 |
| Sample type | Verification | A brief description of the sample | ASTM A108 150 KSI Hex Nuts |
| The quantity of what the sample constitutes | 2 | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Arthur | Last name of sampler or witnessed by | Peterson |
| Title of sampler | QA Inspector | Telephone number of sampler | 7073428602 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Williams Form Engineering-SD | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | L110-134-21 | Structure unique identifier | |
| Structure name | Bid Item | Not set |
Material Information
| Material Type | SMTL TM5 - Threaded Bar | Production or Authorization Testing | Authorization Testing |
|---|---|---|---|
| Threaded Bar Specification | ASTM A722 | Threaded Bar Grade | 150 |
| Threaded Bar Type | Rebar Size | ||
| Nut Specification for Threaded Bar | ASTM A108 | System Manufacturer | Williams Form Engineering San Diego |
| Epoxy Coating Color | NA | Threaded Bar Application | |
| Coating Standards | ASTM A123 galvanized | Bar Heat Number(s) | |
| Nut Heat Number(s) | 8298464 | Bar Lot Number | |
| Nut Lot Number | 26E5D | Coupler Heat Number(s) | |
| Coupler Grade |
Submitted Tests
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||
Test File Attachments
DIME Test ID: 2021-09-13-2-1 ASTM A722-15 (Verified)
DIME Test ID: 2021-09-13-2-2 ASTM A722-15 (Verified)
