Sample Record for 2018-05-07-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211848 DEA: 112T2174 EFIS: 1116000131
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-R37.4 - R46.5
Work Description: (Alternative Delivery) CMGC, San Elijo Highway Bridge Replacement. Replace the San Elijo lagoon highway bridge, construct HOV lanes, construct bike and pedestrian trails and bridge, build multi-use facility at Manchester Ave.
Location Description: IN SAN DIEGO COUNTY IN SOLANA BEACH AND ENCINITAS FROM 0.1 MILE NORTH OF LOMAS SANTA FE DRIVE OVERCROSSING TO 0.2 MILE SOUTH OF BIRMINGHAM DRIVE OVERCROSSING
Contractor Name: Flatiron-Skanska-Stacy and Witbeck, a Joint Venture
Contractor Address: 1770 La Costa Meadows Drive, San Marcos, CA 92078
Resident Engineer: Steve McMillan Structure Rep.: Phong Le
Sample Information
DIME Sample ID: 2018-05-07-1
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 Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 05/07/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 150
A brief description of the sample: headed reinforcing bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp, Fountain Valley, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): xxxx
Head Manufacturer Lot Number(s): 1
Rebar Size: 18
Headed Bar Model Name: Headed Reinforcement
Size of Head: Full Size - 9x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: xxx
Head Manufacturer: HRC
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A955
Headed Bar Unique ID:
Test Results
