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Sample Record for 2021-10-22-5

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Project Information

Project ID: 215220 DEA: 07210624 EFIS: 0719000068 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,SBD-71-1.8/R4.7&R0.0/R0.2
Work Description: PLACE STRUCTURE CONCRETE RETAINING WALLS & BOX CULVERT AND PLACE JPCP.
Location Description: IN LOS ANGELES AND SAN BERNARDINO COUNTIES IN POMONA AND CHINO HILLS FROM 0.2 MILE SOUTH OF MISSION BOULEVARD OVERCROSSING TO 0.2 MILE OF SAN BERNARDINO COUNTY LINE.
Contractor Name: OHL USA
Contractor Address: 1920 Main Street, Suite 310, Irvine, California 92614
Resident Engineer: Michael Wang Structure Rep.: Ryan Valentine

Sample Information

DIME Sample ID: 2021-10-22-5
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: Verification
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 10/22/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/26/2021
The quantity of what the sample constitutes: 2
A brief description of the sample: Epoxy Coated Dowel Basket
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway - Simplex

Material Information

Dowel Metal Heat Number: 201860
Dowel Epoxy Batch Number: 3CH2112012 3CH2117043
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: American Highway Simplex
Dowel Coater: American Highway Simplex
Release Number:
Quality Assurance Code:
Rebar Size (#): #12
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-10-22-5-1
Test Method: ASTM A775-07b-re14: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Holiday)
Verified Date: 10/28/2021
Date Tested: 10/27/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 3
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass
Bend Test Pass/Fail Pass

Test 2 of 2

DIME Test ID: 2021-10-22-5-2
Test Method: ASTM A775-07b-re14: Standard Specification for Epoxy-Coated Steel Reinforcing Bars (Epoxy Coating)
Verified Date: 10/28/2021
Date Tested: 10/27/2021
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 15.36
Second Bar Mean 14.31
Lower spec. limit LSL 7
Upper spec. limit USL 40
Bar # for First Bar 1
Bar # for Second Bar 1
Total mean value 14.83
Total number of values less than LSL no data
Total number of values greater than USL no data