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Sample Record for 2021-09-13-2

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Project Information

Project ID: 213099 DEA: 041A6614 EFIS: 0415000291 COOP: 042683A1 QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-8.4
Work Description: CONSTRUCTION ON STATE HIGHWAY IN MARIN COUNTY IN LARKSPUR
Location Description:
Contractor Name: Disney Construction
Contractor Address: 533 airport Blvd, Suite 120, Burlingame, CA 94010
Resident Engineer: Steven Russell Structure Rep.: Long Ly

Sample Information

DIME Sample ID: 2021-09-13-2
TL Number from the TL Form:
Sample Submitted By Organization: CT QASI - Los Angeles Field Laboratory
Sample Organization Contact: (858) 285-5797
Type of Sample: Verification
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 09/13/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: ASTM A108 150 KSI Hex Nuts
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering-SD

Material Information

Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A108
System Manufacturer: Williams Form Engineering San Diego
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: ASTM A123 galvanized
Bar Heat Number(s):
Nut Heat Number(s): 8298464
Bar Lot Number:
Nut Lot Number: 26E5D
Coupler Heat Number(s):
Coupler Grade:

Test Results

Test 1 of 2

DIME Test ID: 2021-09-13-2-1
Test Method: ASTM A722-15: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
Verified Date: 10/05/2021
Date Tested: 10/05/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: paul.lukkarila@dot.ca.gov
Organization Phone: (916) 227-7253
General Comments for this Test: Nut Test only
Test Result Compliance:
Additional Comments When Verified:
Number of Threaded Bar Samples 1
SampleSizeMfg LotArea (sqin)Tensile Strength (psi)Stress at Offset (psi)Total Elongation (%)Reduction of area (%)CommentsTested By
1ASTM A722 Type I Plain Bar 1 :NUT Heat 8298464 26E5D0.85166019.35136.450100Nut Test onlyfsaylor
Temperature 72 f
UTM 400kip

Test 2 of 2

DIME Test ID: 2021-09-13-2-2
Test Method: ASTM A722-15: Standard Specification for High-Strength Steel Bars for Prestressed Concrete (Tensile)
Verified Date: 10/05/2021
Date Tested: 10/05/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Blvd,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: paul.lukkarila@dot.ca.gov
Organization Phone: (916) 227-7253
General Comments for this Test: Nut Test only
Test Result Compliance:
Additional Comments When Verified:
Number of Threaded Bar Samples 1
SampleSizeMfg LotArea (sqin)Tensile Strength (psi)Stress at Offset (psi)Total Elongation (%)Reduction of area (%)CommentsTested By
1ASTM A722 Type II Deformed Bar 1 : 26mmNUT Heat 8298464 26E5D0.85164664.17137.430100Nut Test onlyfsaylor
Temperature 72 f
UTM 400kip

Tests Assigned to this Sample

DIME Test IDTest MethodAssigned DateTest DateAssigned ByAssigned LabTest CommentsAssigned To
No tests have been assigned to this sample.