Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214342 DEA: 081F9904 EFIS: 0815000095
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-40.1/40.5
Work Description: LENGTHEN ACCELERATION LANE
Location Description: VICTORVILLE FROM 0.5 MILE TO 0.1 MILE SOUTH OF PALMDALE ROAD OVERCROSSING
Contractor Name: DB Electric Inc.
Contractor Address: 7056 Archibald St STE 102-404, Eastvale, CA 92880
Resident Engineer: Shaun Loza Structure Rep.: Unknown
DIME Sample ID: 2021-03-08-2
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: 03/08/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 170
A brief description of the sample: #7 2'-0" diameter welded hoops
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): 4103611
Hoop Manufacturer Lot Number(s): Lot 1 and 2
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 2'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Arizona
Welding Company: CMC Rebar (Etiwanda)
Coating Standards: Uncoated
Weld Type: Flash Welded
