Sample Record for 2021-07-08-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214993 DEA: 051F5004 EFIS: 0514000003
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101,135-70.6/71.2;0.1
Work Description: CONSTRUCT CONCRETE BRIDGE, BRIDGE REMOVAL, COLD PLANE, PLACE HMA.
Location Description: SANTA BARBARA COUNTY AT LOS ALAMOS ON ROUTE 101 FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF ROUTE 101/135 SEPARATION AND ON ROUTE 135 AT ROUTE 101/135 SEPARATION
Contractor Name: CAL PORTLAND CONSTRUCTION
Contractor Address: 1625 E Donovan Road, Santa Maria, CA 93454
Resident Engineer: Jason Torres Structure Rep.: Alex Martinez
Sample Information
DIME Sample ID: 2021-07-08-2
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 - Headed Bars
Sample Taken Date: 07/08/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 28
A brief description of the sample: #11 headed rebar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp, Fountain Valley, CA
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 3500015879
Head Manufacturer Lot Number(s): 1
Rebar Size: #11
Headed Bar Model Name: HRC 120 T Heads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: Nucor Seattle
Head Manufacturer: Headed Reinforcement Corp
Head Fabricator: Headed Reinforcement Corp
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
