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Sample Record for 2020-04-22-1

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 214923 DEA: 081L7104 EFIS: 0820000141 QA Service Level: 1
DIST-CO-RTE-PM: 08--91-
Work Description: Bridge Repair
Location Description:
Contractor Name: Luis Negrete
Contractor Address: 1820 ALHAMBRA BLVD., SACRAMENTO, CA 95816
Resident Engineer: Xavier Avila Structure Rep.: Negrete, Luis

Sample Information

DIME Sample ID: 2020-04-22-1
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 04/22/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: XXXXX
A brief description of the sample: XXXX
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: XXXX
The fabricator/manufacturer/facility name: Integrity Rebar

Material Information

Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: XXXX
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator: Integrity Rebar
Rebar Size: #5
Coupler Model: Zap Screwlok Type 2
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter: NA
Rebar Hoop Fabricator: NA
Coupler Component Heat/Lot Number(s): XXXX
Rebar Heat Number(s): XXXX
Rebar Size 2 : 5

Test Results

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.