Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993193 DEA: 031H18U4 EFIS: 0321000106
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-80-13.0/16.5
Work Description: ROADWAY EXCAVATION, JPCP AND FURNISH POLYESTER CONCRETE OVERLAY.
Location Description: NEVADA COUNTY IN AND NEAR TRUCKEE FROM 0.2 MILE WEST OF DONNER PARK OVERCROSSING TO ROUTE 89/267 SEPARATION
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Randy Stellhorn Structure Rep.: Carl Anderson
DIME Sample ID: 2022-07-22-39
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 07/22/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4,404 LF
A brief description of the sample: 1-1/4" Dowel in Basket (Epoxy Coated)
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway
Dowel Metal Heat Number: 1100028507
Dowel Epoxy Batch Number: CH0472SB
Dowel Coating Specification: ASTM A934
Dowel Size: 1.25 in
Dowel Coating Color: Purple
Dowel Manufacturer: Nucor
Dowel Coater: American Highway
Release Number:
Quality Assurance Code:
Rebar Size (#):
