Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212741 DEA: 020E1804 EFIS: 0200000022
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-89-29.8/30.2
Work Description: BRIDGE REPLACEMENT
Location Description: PLUMAS COUNTY NEAR CANYON DAM FROM 0.2 MILE SOUTH TO 0.3 MILE NORTH OF LAKE ALMANOR SPILLWAY
Contractor Name: Q&D CONSTRUCTION, INC.
Contractor Address: P.O Box 10865, Reno, NV 89510
Resident Engineer: Ryan Johnson Structure Rep.: Matt Crete
DIME Sample ID: 2018-04-23-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 04/23/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Lot 1 2 3 and 4
A brief description of the sample: Resistance Butt Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Etiwanda
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4074397
Hoop Manufacturer Lot Number(s): Lot 1 - 4
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 6
Diameter of Hoop: 1'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Arizona
Welding Company: CMC Rebar (Etiwanda)
Coating Standards: Uncoated
Weld Type: Flash Welded
