Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212743 DEA: 030H26U4 EFIS: 0317000247
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-65-R5.0/R6.6
Work Description: NORTHBOUND WIDENING AND RAMP IMPROVEMENTS.
Location Description: PLACER COUNTY IN AND NEAR ROSEVILLE AND ROCKLIN FROM 0.1 MILE SOUTH OF EAST ROSEVILLE VIADUCT TO 0.5 MILE SOUTH OF PLEASANT GROVE BOULEVARD OVERCROSSING
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd, Benicia, CA 94510
Resident Engineer: Jeff Johnson Structure Rep.: James "Jimmer" Ross
DIME Sample ID: 2018-06-05-1
TL Number from the TL Form: Unknown
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 - Welded Hoops
Sample Taken Date: 06/05/2018
Date that the sample was received by the laboratory/organization performing the testing: 06/06/2018
The quantity of what the sample constitutes: 12
A brief description of the sample: Resistance Butt Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 7
Hoop Manufacturer Lot Number(s): 1-8
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 7
Diameter of Hoop: 5'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: CMC Rebar (Etiwanda)
Coating Standards: Uncoated
Weld Type: Flash Welded
