Sample Record for 2020-12-01-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213856 DEA: 112888U4 EFIS: 1118000199
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-11,125,905-Various
Work Description: CONSTRUCT FREEWAY TO FREEWAY CONNECTORS AND 4-LANE HIGHWAY FACILITY
Location Description: SAN DIEGO COUNTY AT VARIOUS LOCATIONS
Contractor Name: Skanska USA Civil West CA
Contractor Address: 1995 Agua Mansa Road, Riverside, CA 92509
Resident Engineer: Carlos Covarrubias Structure Rep.: Wade Durant
Sample Information
DIME Sample ID: 2020-12-01-1
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 - Headed Bars
Sample Taken Date: 12/01/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 Lot of 74 Headed Bars
A brief description of the sample: No 11 Headed Reinforcement
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name: Alta Road Overcrossing
The fabricator/manufacturer/facility name: Integrity Rebar
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 65029069
Head Manufacturer Lot Number(s): 2N1
Rebar Size: #11
Headed Bar Model Name: Buttonhead BNX
Size of Head: Full Size - 9x
Head Connection Type: Crimped Head
Head Shape: Circular
Rebar Manufacturer: Gerdau
Head Manufacturer: Bar Splice
Head Fabricator: Integrity Rebar
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
