Sample Record for 2020-07-09-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 7613 DEA: 071218W4 EFIS: 0700021119
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-29.4/31.6
Work Description: REALIGN ROUTE 5 AND RAILROAD TRACKS AND RECONFIGURE ON- AND OFF-RAMPS.
Location Description: LOS ANGELES COUNTY IN BURBANK FROM WEST MAGNOLIA BOULEVARD OVERCROSSING TO 0.3 MILE NORTH OF BUENA VISTA STREET/WINONA AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVENUE, SYLMAR, CA 91342
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Gon Choi
Sample Information
DIME Sample ID: 2020-07-09-1
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: Quality Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 07/09/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 36
A brief description of the sample: HRC 500/510 coupled
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier: 19-Los Angeles
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar Placers
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 6503051602
Head Manufacturer Lot Number(s): A190833 / 100799113
Rebar Size: #4
Headed Bar Model Name: 500 and 510
Size of Head: Full Size - 9x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: Gerdau
Head Manufacturer: Integrity Rebar Placers
Head Fabricator: HRC
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
