Project Information

Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670 QA Service Level: 1

DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3

Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.

Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2

Contractor Name: OC 405 Partners

Contractor Address: 3100 W Lake Center Dr, Santa Ana, CA 92704

Resident Engineer: Hank Alonso (reports) Structure Rep.: Alex Angha (reports)

Sample Information

DIME Sample ID: 2019-11-05-2

TL Number from the TL Form: Unknown

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: 11/05/2019

Date that the sample was received by the laboratory/organization performing the testing: 11/08/2019

The quantity of what the sample constitutes: 2

A brief description of the sample: A934 Purple Epoxy Coated Rebar

From where was the sample collected: Source

Laboratory sample identification: Unknown

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Fletcher Coating Co

Material Information

Rebar Heat Number(s): 4087752

Rebar Epoxy Batch Number(s):

Rebar Coating Specification: ASTM A934

Rebar Size (#): 8

Rebar Coating Color: Purple

Rebar Manufacturer: CMC Arizona

Rebar Coater: Fletcher Coating Company

Rebar Powder Manufacturer: Unknown

Release Number: Unknown

Quality Assurance Code: Unknown

Test Results

Test 1 of 2

DIME Test ID: 2019-11-05-2-1

Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Holiday Bend)

Verified Date: 11/14/2019

Date Tested: 11/13/2019

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	3
Total Length	5
Holidays Per Linear Foot of Bar	0.6
Holiday Test Pass/Fail	Pass
Bend Test Pass/Fail	Pass

Test 2 of 2

DIME Test ID: 2019-11-05-2-2

Test Method: ASTM A934-13: Standard Specification for Epoxy-Coated Prefabricated Steel Reinforcing Bars (Epoxy-Coating)