Sample Record for 2020-09-01-7
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete
Sample Information
DIME Sample ID: 2020-09-01-7
TL Number from the TL Form:
Sample Submitted By Organization: CT METS QASI - Los Angeles Design Build Field Laboratory
Sample Organization Contact: (619) 204-7248
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/04/2020
The quantity of what the sample constitutes: 52
A brief description of the sample: #4 Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC Steel Arizona
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator:
Rebar Size: #4
Coupler Model: Double Barrel Zap Screwlok
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 4096761, 4096276
Rebar Heat Number(s): 4096761, 4096276
Rebar Size 2 : 5
Coupler Unique ID:
Test Results
