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Sample Record for 2021-11-30-9

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Project Information

Project ID: 213750 DEA: 120K0224 EFIS: 1214000097 QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-14.5/17.1
Work Description: South County Improvement Project (Phase 2 - Oso/Alicia) CONST BRIDGES, RW, SW, HMA PVMT, JPCP, DRAINAGE, AND ELECT SYSTEMS.
Location Description: ORANGE COUNTY IN MISSION VIEJO AND LAGUNA HILLS FROM 0.7 MILE SOUTH OF OSO PARKWAY OVERCROSSING TO 0.3 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING
Contractor Name: Flatiron West, Inc
Contractor Address: 1770 La Costa Meadows Drive, San Marcos, California 92078
Resident Engineer: John Hong Structure Rep.: Sara Soleimani

Sample Information

DIME Sample ID: 2021-11-30-9
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: 11/30/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2021
The quantity of what the sample constitutes: (4) #8 BNX Buttonhead (9CS-17-01)
A brief description of the sample: #8 BNX Buttonhead (9CS-17-01) Lot #1 ,QA Samples
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar

Material Information

Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 65033318
Head Manufacturer Lot Number(s): A213737
Rebar Size: #8
Headed Bar Model Name: 08BNX 5P1
Size of Head: Full Size - 9x
Head Connection Type: Crimped Head
Head Shape: Circular
Rebar Manufacturer: CMC Rebar
Head Manufacturer: Integrity Rebar
Head Fabricator: Barsplice BNX Buttonheads
Material Standard Code: ASTM A706
Headed Bar Unique ID:

Test Results