Sample Record for 2019-12-26-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213749 DEA: 120C1104 EFIS: 1200000633
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-20.3/21.6
Work Description: SR-57 Lambert Interchange Project: WIDEN BRIDGES AND CONSTRUCT RW, SW, HMA, JPCP AND ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY IN BREA FROM 0.6 MILE SOUTH TO 0.7 MILE NORTH OF LAMBERT ROAD UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Steven Kim Structure Rep.: Theodore Pham
Sample Information
DIME Sample ID: 2019-12-26-1
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: Authorization
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 12/26/2019
Date that the sample was received by the laboratory/organization performing the testing: 12/27/2019
The quantity of what the sample constitutes: 8 SAMPLES
A brief description of the sample: #10 grip twist couplers
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Camblin Steel Services
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC Steel California
Coupler Manufacturer: Steel Dynamic Inc
Intermediate Assembler or Fabricator: Camblin Steel Services Inc
Rebar Size: 10
Coupler Model: GripTwist
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): A193035 MALE, A190418 FEMALE
Rebar Heat Number(s): 9001747
Rebar Size 2 : 10
Coupler Unique ID:
Test Results
