Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210837 DEA: 080J0804 EFIS: 0800000283 COOP: 081625
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-34.7/51.6
Work Description: (Alternative Delivery) DESIGN-BUILD OF THE INTERSTATE 15 EXPRESS LANES PROJECT
Location Description: Riverside County and SBD-15-0.0/1.3
Contractor Name: Skanska-Ames, Joint Venture
Contractor Address: 1801 California Avenue, Corona, CA 92881
Resident Engineer: Roy Fisher (reports) Structure Rep.: Roy Fisher
DIME Sample ID: 2020-01-10-7
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 01/10/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/13/2020
The quantity of what the sample constitutes: 144
A brief description of the sample: #6 Welded Hoops
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Etiwanda
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4092766
Hoop Manufacturer Lot Number(s): 1
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 6
Diameter of Hoop: 4'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Etiwanda
Welding Company: CMC
Coating Standards: Uncoated
Weld Type: Flash Welded
