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Sample Record for 2020-12-10-2

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 214579 DEA: 010B0904 EFIS: 0100020444 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-8.2/8.7
Work Description: Panther Creek & Hunter Creek Bridges
Location Description: DEL NORTE COUNTY NEAR KLAMATH AT PANTHER CREEK BRIDGE AND AT HUNTER CREEK BRIDGE
Contractor Name: Golden State Bridge, Inc
Contractor Address: 3701 Mallard Dr., Benicia, CA 94510
Resident Engineer: Ryan Dunne Structure Rep.: Brian Cinkutis

Sample Information

DIME Sample ID: 2020-12-10-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 12/10/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 24
A brief description of the sample: A 706 #8 with HRC 500/510 #8
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: PJs Rebar

Material Information

Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: HRC
Intermediate Assembler or Fabricator: North Coast Stell
Rebar Size: #8
Coupler Model: HRC500/510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 73112579/A196207
Rebar Heat Number(s): 309983
Rebar Size 2 : 8
Coupler Unique ID:

Test Results