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Sample Record for 2021-12-08-4

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 215063 DEA: 032F5704 EFIS: 0300020615 QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-46.3/63.5
Work Description: Replace 4 Bridges (OC) on Highway 80 from Crystal Springs to Cisco Grove (Baxter, Drum Forebay)
Location Description:
Contractor Name: Walsh Construction Company II, LLC (Walsh)
Contractor Address: 1390 Willow Pass Road Suite 950, Concord, CA 94520
Resident Engineer: Tad Sampson Structure Rep.: Jimmer Ross

Sample Information

DIME Sample ID: 2021-12-08-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Acceptance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 12/08/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/09/2021
The quantity of what the sample constitutes: 158
A brief description of the sample: 1.5 x 18 Purple Epoxy Coated Dowels
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway - Simplex

Material Information

Dowel Metal Heat Number: 323421
Dowel Epoxy Batch Number: 3CH2041027
Dowel Coating Specification: ASTM A934
Dowel Size: 1.5 in
Dowel Coating Color: Purple
Dowel Manufacturer: American Highway Simplex
Dowel Coater: American Highway Simplex
Release Number: 112209-2
Quality Assurance Code:
Rebar Size (#):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-12-08-4-1
Test Method: ASTM A884-14: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Epoxy Coating Thickness)
Verified Date: 12/13/2021
Date Tested: 12/13/2021
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 9.27 mils
Second Bar Mean 8.81 mils
Lower spec. limit LSL 7 mils
Upper spec. limit USL 40 mils
Total mean value 9.04 mils
Total number of values less than LSL no data
Total number of values greater than USL no data

Test 2 of 2

DIME Test ID: 2021-12-08-4-2
Test Method: ASTM A884-13: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Verified Date: 12/13/2021
Date Tested: 12/13/2021
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 1
Total Length 3
Holidays Per Linear Foot of Bar 0.3
Holiday Test Pass/Fail Pass