Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213520 DEA: 120M9004 EFIS: 1213000017
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-22-R5.6/R10.9
Work Description: RECHANNELIZE TO ENHANCE TRAFFIC FLOW
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM 0.1 MILE WEST OF BROOKHURST STREET UNDERCROSSING IN GARDEN GROVE TO BEDFORD ROAD OVERCROSSING IN ORANGE
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 8555 Banana Avenue, Fontana, CA 92335
Resident Engineer: Adrian Wu Structure Rep.: Theodore Pham
DIME Sample ID: 2019-11-01-12
TL Number from the TL Form: NA
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Ductile Iron Cast Samples
Sample Taken Date: 11/01/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/06/2019
The quantity of what the sample constitutes: 2
A brief description of the sample: Coupon Castings
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Farrar
Heat Number (s): H299
Part Number (s): 68 05 144
Material Specification: A536
Grades: 80-55-06
Metal Foundry Manufacturer (Mill): Farrar
Prestressing Manufacturer: DSI
