Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212571 DEA: 051F79A4 EFIS: 0514000061
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-55.9/R56.2
Work Description: Nojoqui Creek Bridge (51-0018 L/R) widening and rail replacement.
Location Description: IN SANTA BARBARA COUNTY NEAR BUELLTON AT NOJOQUI CREEK BRIDGE (BR #51-0018 L/R)
Contractor Name: SOUZA CONSTRUCTION
Contractor Address: 4027 Santa Fe Road, San Luis Obispo, CA 93403
Resident Engineer: David Cooper Structure Rep.: Sal Heredia
DIME Sample ID: 2021-07-07-3
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: 07/07/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 243 Hoops
A brief description of the sample: UBS Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar Etiwanda
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4108651
Hoop Manufacturer Lot Number(s): 1 and 2
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #5
Diameter of Hoop: 1'-11"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC
Welding Company: CMC Etiwanda
Coating Standards: Uncoated
Weld Type: Flash Welded
