Sample Record for 2018-06-29-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2018-06-29-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Acceptance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 06/29/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 150 splices
A brief description of the sample: 10 HRC 500/510 couplers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: ConFab Lathrop
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: HRC USA
Intermediate Assembler or Fabricator: Confab Lathrop
Rebar Size: 10
Coupler Model: HRC 500 510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): Lot 1
Rebar Heat Number(s): 4073764
Rebar Size 2 :
Coupler Unique ID:
Test Results
