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Sample Record for 2019-09-11-7

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: 2019-09-11-7
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 Rebar
Sample Taken Date: 09/11/2019
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2019
The quantity of what the sample constitutes: 400 Loose Ties and 30 Baskets
A brief description of the sample: A934 Coated Tie Bars
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Simplex JC Supply

Material Information

Rebar Heat Number(s): 1202014110
Rebar Epoxy Batch Number(s): CH1729WB
Rebar Coating Specification: ASTM A934
Rebar Size (#): 6
Rebar Coating Color: Purple
Rebar Manufacturer: Nucor
Rebar Coater: Simplex JC Supply
Rebar Powder Manufacturer: Valspar
Release Number:
Quality Assurance Code:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2019-09-11-7-1
Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Epoxy-Coating)
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:
Lower spec. limit LSL 7 mils
Upper spec. limit USL 12 mils
Bar # for First Bar 1
Bar # for Second Bar 2
First Bar Mean 8.61
Second Bar Mean 8.63
Total mean value 8.62

Test 2 of 2

DIME Test ID: 2019-09-11-7-2
Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Holiday Bend)
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 5
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass
Bend Test Pass/Fail Pass