Sample Record for 2018-07-31-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212888 DEA: 07202124 EFIS: 0700020870
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-20.9/24.6
Work Description: PAVEMENT REHABILITATION AND BRIDGE WIDENING
Location Description: LOS ANGELES COUNTY IN AND NEAR BELL, VERNON, AND CITY OF COMMERCE, FROM 0.2 MILE SOUTH OF SLAUSON AVENUE OVERCROSSING TO 0.1 MILE NORTH OF THIRD STREET OVERCROSSING
Contractor Name: FLATIRON WEST, INC.
Contractor Address: 15335 Fairfield Ranch Road, Suite 200, Chino Hills, CA 91709
Resident Engineer: Peter Lee Structure Rep.: James Holloway
Sample Information
DIME Sample ID: 2018-07-31-4
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 Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 07/31/2018
Date that the sample was received by the laboratory/organization performing the testing: 07/31/2018
The quantity of what the sample constitutes: 2
A brief description of the sample: Operator Qualification
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar Etiwanda
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Gerdau
Coupler Manufacturer: HRC
Intermediate Assembler or Fabricator: Hugo Saomera
Rebar Size: 14
Coupler Model: 500 510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 8197393-T2 AIS0128-T2
Rebar Heat Number(s): 6502945502
Rebar Size 2 :
Coupler Unique ID:
Test Results
