*Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Sample Record for 2018-08-06-2


Project Information

Project ID: 212618 DEA: 044G0564 EFIS: 0417000154 QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-680-M2.4/M12.4
Work Description: ROADWAY REHAB, BRIDGE REPLACEMENT, RET. WALLS, TOLL SYSTEMS
Location Description: FREMONT AND AT SUNOL FROM MISSION BOULEVARD SEPARATION TO KOOPMAN ROAD UNDERCROSSING
Contractor Name: BAY CITIES PAVING & GRADING, INC. Contractor Address: 1450 Civic Ct. BLDG B #400
Resident Engineer: Yannaing Tun Structure Rep.: Jarosz, Jordan

Sample Information

DIME Sample ID: 2018-08-06-2
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: (510) 385-8178
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 08/06/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 150
A brief description of the sample: No. 9 Grade 75 epoxy coated bars, and hex nuts
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:

Material Information

Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size:
Nut Specification for Threaded Bar: ASTM A576
System Manufacturer: Williams Form Eng
Epoxy Coating Color: Purple
Threaded Bar Application: Soil Nail
Coating Standards: ASTM A934 epoxy
Bar Heat Number(s): 100890429 100791753
Nut Heat Number(s): 8296508
Bar Lot Number: 100890429042921 10079175321
Nut Lot Number: 9J1D
Coupler Heat Number(s):
Coupler Grade: