Sample Record

Owner Lab

  • G3 Quality, Incorporated - Cerritos

DIME Sample ID 2023-01-04-8

Project Information

Project IdentifiersProject ID: 212112
DEA: 080C2514
EFIS: 0816000076
COOP: 081645
DIST-CO-RTE-PM08-SBD-10-0.0/13.2
Award Date06/06/2018
Closeout DateNot set
Work DescriptionDesign-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location DescriptionLA/SBD County Line to PM 13.2 near I-15
QA Service Level1 (Verified on 10/16/2019)

Sample Information

Sample Taken Date01/04/2023 Sample Unique Key8
Date that the sample was received by the laboratory/organization performing the testing01/11/2023 Sample typePer Request
A brief description of the sample#6 ScrewLok Type 2 Coupler The quantity of what the sample constitutes14
From where was the sample collectedJob Site First name of sampler or witnessed byNestor
Last name of sampler or witnessed byAlvarez Title of samplerInspector
Telephone number of sampler(909) 649-7610 Laboratory sample identification
Linked DIME Sample ID The fabricator/manufacturer/facility nameCMC Rebar
Transportation Laboratory (TL) Number Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier Structure nameMountain Abut Wing Wall
Bid ItemNot set

Material Information

Material TypeSMTL TM5 - Couplers Production or Authorization TestingProduction Testing
Service or UltimateService Material Standard CodeASTM A706
Material Grade60 Rebar ManufacturerCMC Rebar
Coupler ManufacturerBarSplice Intermediate Assembler or Fabricator
Rebar Size#6 Coupler ModelScrewlok Type 2
Coating StandardsUncoated Shape of RebarStraight
Rebar Hoop Diameter Rebar Hoop Fabricator
Coupler Component Heat/Lot Number(s)A216421 Rebar Heat Number(s)4123771
Rebar Size 2 Coupler Unique IDSF-17-03

Submitted Tests

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