Sample Record for 2021-04-18-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214841 DEA: 034H1004 EFIS: 0318000176
QA Service Level: 1
DIST-CO-RTE-PM: 03-SIE-49-9.2/24.7
Work Description: INSTALL RETAINING STRUCTURE AND RSP CONCRETE EMBANKMENT.
Location Description: SIERRA COUNTY ON ROUTE 49 AT VARIOUS LOCATIONS
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO CA 94507
Resident Engineer: Christopher Fallbeck Structure Rep.: Jimmer Ross
Sample Information
DIME Sample ID: 2021-04-18-2
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 - Headed Bars
Sample Taken Date: 04/18/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 75
A brief description of the sample: #6 HRC 555 Reduced Size
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Steel Group
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 1202029290
Head Manufacturer Lot Number(s): Lot 1
Rebar Size: #6
Headed Bar Model Name: HRC Type 555
Size of Head: Reduced Size - 4x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: HRC
Head Fabricator: Pacific Steel Group
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
