Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212657 DEA: 024G5004 EFIS: 0214000031
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-299-1.9-2.3
Work Description: VIADUCT WIDENING
Location Description: TRINITY COUNTY NEAR SALYER FROM 0.1 MILE EAST TO 0.6 MILE EAST OF WHITE HOUSE GULCH ROAD
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Mandhir Grewal Structure Rep.: Michael Mccracken
DIME Sample ID: 2020-03-03-4
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 - Welded Hoops
Sample Taken Date: 03/03/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/13/2020
The quantity of what the sample constitutes: 4 samples from Lot 1 to 10
A brief description of the sample: (40) 1'-6" Ø Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 3093021
Hoop Manufacturer Lot Number(s): Lot 1 to 10
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 6
Diameter of Hoop: 1'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Steel CA
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
