Sample Record for 2019-02-18-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213442 DEA: 112E1504 EFIS: 1117000179
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-38.1/39.3
Work Description: (ALTERNATIVE DELIVERY) WETLAND CONSTRUCTION
Location Description: NEAR STATE HIGHWAY IN SAN DIEGO COUNTY IN SOLANA BEACH AND ENCINITAS AT VARIOUS LOCATIONS
Contractor Name: Flatiron-Skanska-Stacey and Witbeck, a Joint Venture
Contractor Address: 3091 Manchester Avenue, Cardiff, CA 92007
Resident Engineer: Jared Corbitt Structure Rep.: Phong Le
Sample Information
DIME Sample ID: 2019-02-18-1
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 Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 02/18/2019
Date that the sample was received by the laboratory/organization performing the testing: 02/26/2019
The quantity of what the sample constitutes: Lot 1 - 42
A brief description of the sample: HRC 500 510 Couplers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Gerdau
Coupler Manufacturer: Gerdau and Jade Sterling Steel
Intermediate Assembler or Fabricator: FSSW
Rebar Size: 11
Coupler Model: HRC 500-510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter: NA
Rebar Hoop Fabricator: NA
Coupler Component Heat/Lot Number(s): 500 - Z82834A
510 - 74112074
Rebar Heat Number(s): 6503256702
Rebar Size 2 : 11
Coupler Unique ID:
Test Results
