Sample Record for 2021-10-08-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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: 2021-10-08-3
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 - Headed Bars
Sample Taken Date: 10/08/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2021
The quantity of what the sample constitutes: 4
A brief description of the sample: (16) #8 HRC 555
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: Production Testing
Rebar Heat Number(s): 2121269
Head Manufacturer Lot Number(s): Lot 1
Rebar Size: #8
Headed Bar Model Name: HRC 555
Size of Head: Reduced Size - 4x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: Vinton Steel
Head Manufacturer: Camblin Steel
Head Fabricator: Camblin Steel
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
