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Sample Record for 2020-07-22-2

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

Project Information

Project ID: 214481 DEA: 073118U4 EFIS: 0719000209 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-107-0.0/4.8
Work Description: PLACE RHMA AND JPCP, AND MODIFY ELECTRICAL SYSTEM.
Location Description: LOS ANGELES COUNTY IN TORRANCE FROM ROUTE 1 TO REDONDO BEACH BOULEVARD
Contractor Name: AUTOBAHN CONSTRUCTION
Contractor Address: 933 N Batavia St,, Orange, CA 92867
Resident Engineer: Thang Ton Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-07-22-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 07/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2020
The quantity of what the sample constitutes: 1 epoxy coated dowel basket 12 bar
A brief description of the sample: Dowel basket and wire
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Simplex - Fernley, NV

Material Information

Dowel Metal Heat Number: 1202022488
Dowel Epoxy Batch Number:
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer:
Dowel Coater: Simplex JC Supply
Release Number:
Quality Assurance Code:
Rebar Size (#):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2020-07-22-2-1
Test Method: ASTM A884-13: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Verified Date: 07/29/2020
Date Tested: 07/29/2020
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 3
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass

Test 2 of 2

DIME Test ID: 2020-07-22-2-2
Test Method: ASTM A884-14: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Epoxy Coating Thickness)
Verified Date: 07/29/2020
Date Tested: 07/29/2020
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 10.58 mils
Second Bar Mean 14.25 mils
Lower spec. limit LSL 7 mils
Upper spec. limit USL 40 mils
Total mean value 12.42 mils
Total number of values less than LSL no data
Total number of values greater than USL no data