Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2018-07-25-5
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: 07/25/2018
Date that the sample was received by the laboratory/organization performing the testing: 07/25/2018
The quantity of what the sample constitutes: 2
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: Martinez steel
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): x
Hoop Manufacturer Lot Number(s): x
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 4
Diameter of Hoop: 3'-5"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: x
Welding Company: Martinez Steel
Coating Standards: Uncoated
Weld Type: Flash Welded
