Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 3825 DEA: 07138204 EFIS: 0700000142
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-47,103-3.5/4.6,0.0/1.1
Work Description: REPLACE STEEL BRIDGE WITH CIP PS CONCRETE BOX GIRDER BRIDGE AND RAMPS.
Location Description: LOS ANGELES COUNTY IN LONG BEACH AND LOS ANGELES ON ROUTE 47 FROM OCEAN BOULEVARD TO ROUTE 103 JUNCTION AND ON ROUTE 103 FROM ROUTE 47 JUNCTION TO ANAHEIM STREET OVERHEAD
Contractor Name: M C M CONSTRUCTION INC
Contractor Address: P O BOX 620, NORTH HIGHLANDS, CA 95660
Resident Engineer: Daniel Leon Structure Rep.: Andy Chen
DIME Sample ID: 2019-09-11-4
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 - Headed Bars
Sample Taken Date: 09/11/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 369
A brief description of the sample: #10 Rebar with HRC 120 T Heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 33428N802
Head Manufacturer Lot Number(s): 114 thru 116
Rebar Size: 10
Headed Bar Model Name: HRC 120 THeads
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Square
Rebar Manufacturer: CMC
Head Manufacturer: HRC
Head Fabricator: HRC
Material Standard Code: ASTM A706
Headed Bar Unique ID:
