Sample Record for 2020-01-29-12
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213764 DEA: 080F0304 EFIS: 0800020358
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-60-R0.7/R3.0
Work Description: REMOVE AND REPLACE THREE OVERCROSSING BRIDGES ON ROUTE 60
Location Description: IN SAN BERNARDINO COUNTY IN AND NEAR CHINO AT VARIOUS LOCATIONS FROM O.1 MILE WEST OF PIPELINE AVENUE OVERCROSSING TO 0.1 MILE EAST OF BENSON AVENUE OVERCROSSING
Contractor Name: SEMA CONSTRUCTION, INC.
Contractor Address: 42690 Rio Nedo, Suite G, Temecula, CA 92590
Resident Engineer: Joseph Lopez Structure Rep.: Rodrigo Santa Cruz
Sample Information
DIME Sample ID: 2020-01-29-12
TL Number from the TL Form: L133-016-20
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 - Couplers
Sample Taken Date: 01/29/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/31/2020
The quantity of what the sample constitutes: 8 coupled bars
A brief description of the sample: #6 Rebar Coupled bars Lot 1, 2
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar Placers
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator:
Rebar Size: 6
Coupler Model: 6DBZA
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 8249
Rebar Heat Number(s): 4088284
Rebar Size 2 : 6
Coupler Unique ID:
Test Results
