Sample Record for 2021-11-30-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2021-11-30-2
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 - Headed Bars
Sample Taken Date: 11/30/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/07/2021
The quantity of what the sample constitutes: (11) #5 HRC 120 X 18'-0"
A brief description of the sample: (4) #5 HRC 120 X 18'-0"
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4111735
Head Manufacturer Lot Number(s): LOT 1
Rebar Size: #5
Headed Bar Model Name: HRC 120 9FW 17 03
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Rebar
Head Manufacturer: NUCOR HRC HEAT NO 10021114224
Head Fabricator: HRC
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
