Sample Record for 2021-05-27-14
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214355 DEA: 120K0214 EFIS: 1214000096
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Kifah Ramadan Structure Rep.: Imad Karam
Sample Information
DIME Sample ID: 2021-05-27-14
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 - Couplers
Sample Taken Date: 05/27/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: (16) #5 D101A Dowel Bar (D-B)
A brief description of the sample: Dayton Superior D101A Dowel Bar (SF-17-01)
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Coreslab Structures L A Inc
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor
Coupler Manufacturer: Dayton Superior
Intermediate Assembler or Fabricator: Coreslab Structures L A Inc
Rebar Size: #5
Coupler Model: SF-17-01
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter: NA
Rebar Hoop Fabricator: NA
Coupler Component Heat/Lot Number(s): 128314
Rebar Heat Number(s): 3500014854
Rebar Size 2 : 5
Coupler Unique ID:
Test Results
