Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214640 DEA: 042J7204 EFIS: 0415000016
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-580-1.17
Work Description: STEGE DRAIN SUPER-STRUCTURE, PRECAST VOIDED SLABS
Location Description: CONTRA COSTA COUNTY IN RICHMOND FROM 0.3 MILE EAST OF STEGE DRAIN BRIDGE TO 0.3 MILE WEST OF BAYVIEW AVENUE OVERCROSSING
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO CA 94507
Resident Engineer: Luis Melendez Structure Rep.: Laraine Woo
DIME Sample ID: 2022-09-09-2
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: 09/09/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 10
A brief description of the sample: #8 HRC 120 T-Head
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 60300477
Head Manufacturer Lot Number(s): 10010900121
Rebar Size: #8
Headed Bar Model Name: 120
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC
Head Manufacturer: HRC
Head Fabricator: HRC
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
