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Sample Record for 2022-01-13-4

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

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: 2022-01-13-4
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: 01/13/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 38
A brief description of the sample: Headed Bar
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): 1202035022
Head Manufacturer Lot Number(s): 2
Rebar Size: #8
Headed Bar Model Name: Tapered Threaded DoughNUT
Size of Head: Full Size - 9x
Head Connection Type: Taper Threaded
Head Shape: Circular
Rebar Manufacturer: Nucor
Head Manufacturer: Bar Splice Products
Head Fabricator: Bar Splice Products
Material Standard Code: ASTM A615
Headed Bar Unique ID:

Test Results