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

Sample Record for 2018-11-14-1


Project Information

Project ID: 212036 DEA: 044K2404 EFIS: 0417000284 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-10.9
Work Description: Construct Solier Pile Wall
Location Description:
Contractor Name: DRILL TECH DRILLING & SHORING Contractor Address: 2200 WYMORE WAY
Resident Engineer: Dawit Habteselassie Structure Rep.: Kress, Jeff

Sample Information

DIME Sample ID: 2018-11-14-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 11/14/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 300
A brief description of the sample: Galv hoolow bars, hex nuts and couplers
From where was the sample collected: Distributor
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:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A29
System Manufacturer: unknown
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: ASTM A153 galvanized
Bar Heat Number(s): 4120583 and 4121251
Nut Heat Number(s): 8296322
Bar Lot Number:
Nut Lot Number: 38-85D
Coupler Heat Number(s): 100889235
Coupler Grade: A615 Gr 75