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Sample Record for 2019-09-11-6

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

Project Information

Project ID: 213274 DEA: 010C8104 EFIS: 0113000060 QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-20,53-31.1/31.8,7.0/7.4
Work Description: CONSTRUCT ROUNDABOUT
Location Description: LAKE COUNTY NEAR CLEARLAKE OAKS ON ROUTE 20 FROM 0.5 MILE WEST TO 0.2 MILE EAST OF ROUTE 53 AND ON ROUTE 53 FROM 0.4 MILE SOUTH OF ROUTE 20 TO ROUTE 20
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Dan Kraft Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2019-09-11-6
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 TM7 - Epoxy Coated Dowels
Sample Taken Date: 09/11/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/01/2019
The quantity of what the sample constitutes: 222 Dowel Bar Baskets
A brief description of the sample: A934 Coated Dowels
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name: BI 56
The fabricator/manufacturer/facility name: Simplex JC Supply

Material Information

Dowel Metal Heat Number: 3089193
Dowel Epoxy Batch Number: CH1729WB
Dowel Coating Specification: ASTM A934
Dowel Size: 1.25 in
Dowel Coating Color: Purple
Dowel Manufacturer: CMC
Dowel Coater: Simplex JC Supply
Release Number:
Quality Assurance Code:
Rebar Size (#):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2019-09-11-6-1
Test Method: ASTM A884-14: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Epoxy Coating Thickness)
Verified Date: 09/19/2019
Date Tested: 09/19/2019
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 8.46 mils
Second Bar Mean 7.91 mils
Lower spec. limit LSL 7 mils
Upper spec. limit USL 12 mils
Total mean value 8.18 mils
Total number of values less than LSL no data
Total number of values greater than USL no data

Test 2 of 2

DIME Test ID: 2019-09-11-6-2
Test Method: ASTM A884-13: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Verified Date: 09/19/2019
Date Tested: 09/19/2019
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 18
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass