Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213469 DEA: 024C40V4 EFIS: 0218000125
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-5-R3.8/R11.7
Work Description: WIDEN TO 6 LANES, BRIDGE REPLACEMENT AND WIDENING AND ROADWAY REHAB
Location Description: SHASTA COUNTY IN AND NEAR ANDERSON FROM ROUTE 5/273 SEPARATION TO 0.4 MILE SOUTH OF CHURN CREEK ROAD OVERCROSSING
Contractor Name: J.F. SHEA CONSTRUCTION
Contractor Address: P.O. BOX 494519, REDDING, CA 96049-4519
Resident Engineer: Henry Benner Structure Rep.: Eric Chaffee
DIME Sample ID: 2019-04-05-5
TL Number from the TL Form: C9469885
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 - Headed Bars
Sample Taken Date: 04/05/2019
Date that the sample was received by the laboratory/organization performing the testing: 04/08/2019
The quantity of what the sample constitutes: 4 lots
A brief description of the sample: #5 T-Head bars
From where was the sample collected: Fabricator
Laboratory sample identification: 2428
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 6503314402
Head Manufacturer Lot Number(s): B1126696
Rebar Size: 5
Headed Bar Model Name: Nucor
Size of Head: Reduced Size - 4x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC
Head Manufacturer: Nucor
Head Fabricator: Nucor
Material Standard Code: ASTM A706
Headed Bar Unique ID:
