Sample Record for 2021-09-22-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215164 DEA: 07317304 EFIS: 0715000237
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60-0.0/R3.2,11.8/R21.5
Work Description: UPGRADE EXISTING OVERHEAD AND ROADSIDE SIGN PANELS.
Location Description: LOS ANGELS COUNTY FROM 0.4 MILE WEST OF ROUTE 5/60 SEPARATION TO ROUTE 60/710 SEPARATION AND FROM ROUTE 60/605 SEPARATION TO FAIRWAY DRIVE UNDERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 CONSTRUCTION CIRCLE WEST, IRVINE CA 92606
Resident Engineer: Myrna Dominguez Structure Rep.: Avtar Bains
Sample Information
DIME Sample ID: 2021-09-22-1
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 Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2021
The quantity of what the sample constitutes: (4) #6 ZAP Screwlok Type 2 Series (SL-17-03)
A brief description of the sample: Prequalification
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Camblin Steel Service
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor
Coupler Manufacturer: Zap Screwlok SL
Intermediate Assembler or Fabricator:
Rebar Size: #6
Coupler Model: SL-17-03
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 74117560
Rebar Heat Number(s): 6024758
Rebar Size 2 : 6
Coupler Unique ID:
Test Results
