Sample Record for 2022-04-15-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993124 DEA: 101F1704 EFIS: 1016000032
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-26,99-1.1,19.3
Work Description: REMOVE AND REPLACE BRIDGE.
Location Description: SAN JOAQUIN COUNTY NEAR STOCKTON AT ROUTE 26/99 SEPARATION
Contractor Name: Andrew M Jordan Inc, DBA A & B Construction
Contractor Address: 1350 4th Street, Berkeley, CA 94710
Resident Engineer: Troy Scheiber Structure Rep.: Chuck Pazzi
Sample Information
DIME Sample ID: 2022-04-15-2
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: 04/15/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 109
A brief description of the sample: Anchor Bolt Assembly
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Stinger Bridge Iron
Material Information
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A529
Threaded Bar Grade: 55
Threaded Bar Type: Plain
Rebar Size:
Nut Specification for Threaded Bar: ASTM A29
System Manufacturer: A563
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: ASTM A153 galvanized
Bar Heat Number(s): 3110391
Nut Heat Number(s): 5804527106
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
Test Results
