Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214909 DEA: 120N8604 EFIS: 1214000123
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-73-23.7/24.1
Work Description: REPLACE STRUCTURAL CONCRETE BRIDGE & RETAINING WALL; & PLACE HMA.
Location Description: ORANGE COUNTY IN NEWPORT BEACH FROM 0.3 MILE NORTH OF BISON AVENUE TO 0.3 MILE SOUTH OF UNIVERSITY DRIVE
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 26320 LESTER CIRCLE, CORONA CA 92883
Resident Engineer: Jay Joubeen Structure Rep.: Ali Jenabzadeh
DIME Sample ID: 2020-10-14-11
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 Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 10/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/16/2020
The quantity of what the sample constitutes: 1 lot total 50 hoops
A brief description of the sample: #7 rebar hoops, 4'-2" diameter
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Etiwanda
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4099893
Hoop Manufacturer Lot Number(s): Lot 1
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 4'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Steel AZ
Welding Company: CMC Rebar (Etiwanda)
Coating Standards: Uncoated
Weld Type: Flash Welded
