Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-12-07-1
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: Recertification
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 12/07/2021
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 samples
A brief description of the sample: #6 A775 Epoxy Coated Reinforcement
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Coating (Farwest)
Rebar Heat Number(s): 1202037498
Rebar Epoxy Batch Number(s): XF92070NA
Rebar Coating Specification: ASTM A775
Rebar Size (#): 5
Rebar Coating Color: Green
Rebar Manufacturer: Nucor
Rebar Coater: Western
Rebar Powder Manufacturer: Akzonobel
Release Number:
Quality Assurance Code:
