Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213958 DEA: 010F9604 EFIS: 0116000109
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-124.5
Work Description: LITTLE LOST MAN FISH PASSAGE
Location Description: HUMBOLDT COUNTY NEAR ORICK 0.2 MILE SOUTH OF LOST MAN CREEK BRIDGE
Contractor Name: MCCULLOUGH CONSTRUCTION INC
Contractor Address: 57 Aldergrove Rd., Arcata, CA 95521
Resident Engineer: Karen Sanders Structure Rep.: Brian Cinkutis
DIME Sample ID: 2020-04-17-3
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: 04/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2020
The quantity of what the sample constitutes: 3 Lots (380 Hoops)
A brief description of the sample: #5x 2'-6" Dia 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): 1912184
Hoop Manufacturer Lot Number(s): Lot 1-3
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #5
Diameter of Hoop: 2'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Vinton Steel
Welding Company: RKR
Coating Standards: Uncoated
Weld Type: Flash Welded
