Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208945 DEA: 07288604 EFIS: 0700021080 COOP: 074663
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-6.0-9.4
Work Description: Gerald Desmond Bridge Replacement - A Design Build project. IQA samples will be selected by Port/Caltrans representatives and sent to Translab for testing.
Location Description: Port of Long Beach (District 7)
Contractor Name: Shimmick/FCC/Impregilo (SFI) JV
Contractor Address: 11 Golden Shore, Suite 330, Long Beach, CA 90802
Resident Engineer: Structure Rep.:
DIME Sample ID: 2018-11-01-6
TL Number from the TL Form: C741326
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 TM6 - Steel Check Sample Plate
Sample Taken Date: 11/01/2018
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2018
The quantity of what the sample constitutes: 1
A brief description of the sample: A709 Steel Check Sample
From where was the sample collected: Fabricator
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: XKT Engineering
Heat Number(s): D4327
Material Specification: A709
Grade: 50W
Thickness: 0.6875"
Shape: Plate
Metal Foundry Manufacturer (Mill): Arcelormittal Plate
Plate Dimension: 12" x 12"
