Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215255 DEA: 040A7714 EFIS: 0420000287
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-80-6.4-6.6
Work Description: CONSTRUCT PEDESTRIAN OVERCROSSING BRIDGE AND RETAINING WALLS. GILMAN INTERCHANGE IMPROVEMENTS
Location Description: ALAMEDA COUNTY IN BERKELEY FROM 0.6 MILE NORTH OF UNIVERSITY AVENUE OVERCROSSING TO 0.1 MILE SOUTH OF GILMAN STREET UNDERCROSSING
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Rebecca Perng Structure Rep.: Eric Urmeneta
DIME Sample ID: 2021-09-30-4
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: 09/30/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: (16) #7 3'-6" Ø Lot 1 thru 4
A brief description of the sample: (528) #7 3'-6" Ø Lot 1 thru 4
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TNT Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 3105807
Hoop Manufacturer Lot Number(s): Lot 1 thru 4
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 3'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Rebar
Welding Company: TNT Rebar
Coating Standards: Uncoated
Weld Type: Flash Welded
