Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213411 DEA: 030H10U4 EFIS: 0317000246
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-5-9.7/24.9
Work Description:
Location Description: Construction on state highway in Sacramento County in and near Sacramento from 1.1 miles south of Elk Grove Boulevard to American River Viaduct
Contractor Name: NOR CAL PAVING TEICHERT/GRANITE
Contractor Address: 400 Sunrise Ave. Ste. #300, Roseville, CA 95661
Resident Engineer: Daniel Tecle Structure Rep.: Pha Tran
DIME Sample ID: 2020-09-22-1
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - West Sacramento
Sample Organization Contact: (916) 662-1777
Type of Sample: Acceptance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2020
The quantity of what the sample constitutes: 150 Couplers
A brief description of the sample: #11 Grip-Twist Coupler
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Beach Lake Bridge
The fabricator/manufacturer/facility name: BarSplice
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Camblin Steel
Coupler Manufacturer: BarSplice Products Inc
Intermediate Assembler or Fabricator:
Rebar Size: #11
Coupler Model: Barsplice Taper Grip-Twist
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 1
Rebar Heat Number(s): 3095554
Rebar Size 2 :
Coupler Unique ID:
