Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208942 DEA: 100Y2104 EFIS: 1013000104 COOP: 10415
QA Service Level: 1
DIST-CO-RTE-PM: 10-TUO-108-R4.3/R5.1
Work Description: MODIFY AND WIDEN STRUCTURE
Location Description: AT PEACEFUL OAK ROAD INTERCHANGE ,PART OF EAST SONORA BYPASS
Contractor Name: SIERRA MOUNTAIN CONSTRUCTION INC.
Contractor Address: 13919 Mono Way, Sonora, CA 95370
Resident Engineer: Corey Casey Structure Rep.: Ehab Wahed
DIME Sample ID: 2021-03-17-2
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: 03/17/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: (4) #7 4'-8" Ø
A brief description of the sample: 1 lot of (144) #7 4'-8" Ø
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TNT Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 2012550
Hoop Manufacturer Lot Number(s): Lot 1
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 4'-8"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Vinton Steel
Welding Company: TNT Rebar
Coating Standards: Uncoated
Weld Type: Flash Welded