Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405,73,405,605-9.3/24.3
Work Description: (Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location Description: Orange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
Contractor Name: OC 405 Partners
Contractor Address: 3100 W Lake Center Dr, Santa Ana, CA 92704
Resident Engineer: Hank Alonso (reports) Structure Rep.: Alex Angha (reports)
DIME Sample ID: 2020-04-23-1
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: Acceptance
Type of Material: SMTL TM6 - Ductile Iron Cast Samples
Sample Taken Date: 04/23/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 15
A brief description of the sample: Material was subject to fire and high heat. Testing will provide acceptance of material. Varied sizes of steel reinforcement bars cut from field. and set of control from same heat
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Tolbert Ave Wingwall
The fabricator/manufacturer/facility name: CMC
Heat Number (s): na
Part Number (s): na
Material Specification: A536
Grades: 80-55-06
Metal Foundry Manufacturer (Mill): na
Prestressing Manufacturer: na
