Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208945 DEA: 07288604 EFIS: 0700021080 COOP: 074663
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-6.0-9.4
Work Description: Gerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location Description: Port of Long Beach (District 7)
Contractor Name: Shimmick/FCC/Impregilo (SFI) JV
Contractor Address: 11 Golden Shore, Suite 330, Long Beach, CA 90802
Resident Engineer: Structure Rep.:
DIME Sample ID: 2017-10-20-2
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Independent Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 10/20/2017
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 11 Lots
A brief description of the sample: HRC T-Heads
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): xxxx
Head Manufacturer Lot Number(s): xxxx
Rebar Size: #11
Headed Bar Model Name: HRC 555
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: xxxx
Head Manufacturer: xxxx
Head Fabricator: xxxx
Material Standard Code: ASTM A706
Headed Bar Unique ID:
