Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212244 DEA: 044G8404 EFIS: 0413000051
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-128-20.1/20.4
Work Description: REPLACE CAPELL CREEK BRIDGE
Location Description: NAPA COUNTY ABOUT 15 MILES EAST OF RUTHERFORD FROM 1.1 MILES EAST OF KNOXVILLE ROAD TO 0.3 MILE WEST OF CAPELL VALLEY CREST
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO CA 94507
Resident Engineer: Darren Isada Structure Rep.: Nana Budu
DIME Sample ID: 2019-07-22-3
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 Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 07/22/2019
Date that the sample was received by the laboratory/organization performing the testing: 07/02/2019
The quantity of what the sample constitutes: 10 Lots
A brief description of the sample: #4 Flash Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4082952
Hoop Manufacturer Lot Number(s): Lots 1 - 10
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 4
Diameter of Hoop: 2'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Rebar
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
