Sample Record for 2020-09-18-26
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214426 DEA: 030A5704 EFIS: 0300020593
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB-20-13.3/R18.2
Work Description: Browns Valley Rehab: CONSTRUCT BRIDGE, REALIGN CURVE, WIDEN SHOULDERS AND CULVERT WORK.
Location Description: YUBA COUNTY FROM MARYSVILLE ROAD TO THE YUBA RIVER BRIDGE
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 400 Sunrise Ave, Suite 300, Roseville, CA 95661
Resident Engineer: Garrett Griffith Structure Rep.: Matt Crete
Sample Information
DIME Sample ID: 2020-09-18-26
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/18/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 Lot of 150
A brief description of the sample: # 6 double barrel Zap screwlok
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Steel Goup
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Cascade Steel
Coupler Manufacturer: BarSplice
Intermediate Assembler or Fabricator:
Rebar Size: #6
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): 0022
Rebar Heat Number(s): 350008586
Rebar Size 2 :
Coupler Unique ID:
Test Results
