Sample Record for 2021-09-07-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215063 DEA: 032F5704 EFIS: 0300020615
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-46.3/63.5
Work Description: Replace 4 Bridges (OC) on Highway 80 from Crystal Springs to Cisco Grove (Baxter, Drum Forebay)
Location Description:
Contractor Name: Walsh Construction Company II, LLC (Walsh)
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Tad Sampson Structure Rep.: Jimmer Ross
Sample Information
DIME Sample ID: 2021-09-07-6
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: 09/07/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/14/2021
The quantity of what the sample constitutes: Lot 1 (32) #11 HRC 120 x various lenght
A brief description of the sample: (32) #11 HRC 120 x various length
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corp
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 3097863
Head Manufacturer Lot Number(s): Lot 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: Circular
Rebar Manufacturer: CMC
Head Manufacturer: HRC Fountain Valley
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
