Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212245 DEA: 024F8604 EFIS: 0213000043
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-36-26.7/27.1
Work Description: ROADWAY REALIGNMENT AND NEW BRIDGE CONSTRUCTION
Location Description: TRINITY COUNTY ABOUT 9 MILES EAST OF FOREST GLEN FROM 0.6 MILE WEST TO 0.1 MILE WEST OF ROUTE 3
Contractor Name: Steelhead Constructors
Contractor Address: 2940 INNSBRUCK DRIVE, REDDING CA 96003
Resident Engineer: Joel Gasik Structure Rep.: Michael D Sears
DIME Sample ID: 2020-06-24-3
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: 06/24/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2020
The quantity of what the sample constitutes: 8 Samples from lot 1-2
A brief description of the sample: #6 x 5'-2" Dia.
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TNT Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 1201021017
Hoop Manufacturer Lot Number(s): 1
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 5'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: TNT Rebar
Coating Standards: Uncoated
Weld Type: Flash Welded
