Sample Record for 2020-01-21-4
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: 2020-01-21-4
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 Control
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 01/21/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/24/2020
The quantity of what the sample constitutes: 48
A brief description of the sample: #10 HRC 120 T-Heads
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp, Fountain Valley, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 9002036
Head Manufacturer Lot Number(s): 2
Rebar Size: 10
Headed Bar Model Name: HRC 120 THeads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Rancho Cucamonga
Head Manufacturer: Headed Reinforcement Corp
Head Fabricator: Headed Reinforcement Corp
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
