Sample Record for 2018-05-08-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212688 DEA: 080Q8904 EFIS: 0800020582
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV,SBD-10,215,111-Var
Work Description: BRIDGE REHABILITATION
Location Description: RIVERSIDE AND SAN BERNARDINO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: J. MCLOUGHLIN ENGINEERING CO., INC.
Contractor Address: 10641 FULTON COURT, RANCHO CUCAMONGA CA 91730
Resident Engineer: Roberto Castro Structure Rep.: Arnel L. Vega
Sample Information
DIME Sample ID: 2018-05-08-4
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 Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 05/08/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Unknown Quantity
A brief description of the sample: zap screw lock type 2
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Steel Placers
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A615
Material Grade: 60
Rebar Manufacturer: unknown
Coupler Manufacturer: American Steel Placers
Intermediate Assembler or Fabricator:
Rebar Size: unknown
Coupler Model: unknown
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): unknown
Rebar Heat Number(s): unknown
Rebar Size 2 :
Coupler Unique ID:
Test Results
