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Sample Record for 2022-03-25-8

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

Project Information

Project ID: 215371 DEA: 042W1204 EFIS: 0421000139 QA Service Level: 1
DIST-CO-RTE-PM: 04-CC,CC/MRN-580-6.9/7.8, 6.9, 7.8, 02, 5
Work Description: REPLACEMENT OF GUSSET PLATES AT VARIOUS LOCATIONS
Location Description: Richmond San Rafael Bridge
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: Behzad Halali Structure Rep.: William Sommer

Sample Information

DIME Sample ID: 2022-03-25-8
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 03/25/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/31/2022
The quantity of what the sample constitutes: 20
A brief description of the sample: 1-1/8x71" A354 BD ATR HDG
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name: RSR Bridge
The fabricator/manufacturer/facility name: Liberty Bolt (for LeJeune)

Material Information

Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A354
Threaded Bar Grade: 414
Threaded Bar Type: Plain
Rebar Size:
Nut Specification for Threaded Bar: na
System Manufacturer: na
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: Uncoated
Bar Heat Number(s): 11722380
Nut Heat Number(s):
Bar Lot Number: 2203252-2
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:

Test Results