Sample Record for 2019-10-28-8
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212036 DEA: 044K2404 EFIS: 0417000284
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN,MRN-1-10.9, 10.8/10.9, 10.90, 6.6/10.9
Work Description: Construct Solier Pile Wall
Location Description:
Contractor Name: Drill Tech
Contractor Address: 2200 WYMORE WAY, ANTIOCH, CA 94509
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeff Kress
Sample Information
DIME Sample ID: 2019-10-28-8
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 TM5 - Threaded Bar
Sample Taken Date: 10/28/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 800
A brief description of the sample: B7X Nuts for 38mm GDIA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering
Material Information
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A513
Threaded Bar Grade: 513
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A108
System Manufacturer: Willaims Form Engineering
Epoxy Coating Color: NA
Threaded Bar Application: Soil Nail
Coating Standards: ASTM A123 galvanized
Bar Heat Number(s): 4173505 and 4124818
Nut Heat Number(s): 8295752
Bar Lot Number: C21032757 and C21032856
Nut Lot Number:
Coupler Heat Number(s): M54421
Coupler Grade: 90
Test Results
