Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993322 DEA: 010L4204 EFIS: 0122000008
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN,MEN/MEN-101-4/6, 4.0/6.0
Work Description: Landslide Repair near Commisky
Location Description:
Contractor Name: MALCOLM DRILLING COMPANY, INC.
Contractor Address: 246 GHILOTTI AVENUE, SANTA ROSA, CA 95407
Resident Engineer: Katharine Perrin Structure Rep.: Kitt Tongthaworn
DIME Sample ID: 2021-11-10-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 11/10/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 150
A brief description of the sample: Flash Welded Rebar Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Conco Reinforcing Benicia
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Rebar Heat Number(s): 1234
Hoop Manufacturer Lot Number(s): 1234
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #8
Diameter of Hoop: 4'-5"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: Conco
Coating Standards: Uncoated
Weld Type: Flash Welded
