Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212211 DEA: 044K5004
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-33.4, 33.40
Work Description: construct sheet pile wall, bio-armoring
Location Description:
Contractor Name: TEAM GHILOTTI INC
Contractor Address: 2531 PETALUMA BLVD SOUTH, PETALUMA CA 94952
Resident Engineer: Hal Streeter Structure Rep.: Sarah Rusby
DIME Sample ID: 2017-09-18-5
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3674 - Pacifica 2
Sample Organization Contact: (510) 714-7639
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/18/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: lot of 150 bars
A brief description of the sample: 4 number 8 bar couplers twist off type
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valitine Construction
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Tamco
Coupler Manufacturer: Dayton Superior
Intermediate Assembler or Fabricator:
Rebar Size: 8
Coupler Model: D250SCA
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): Barlock Couplers
Rebar Heat Number(s): will follow
Rebar Size 2 :
Coupler Unique ID:
