Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993235 DEA: 051H4504 EFIS: 0516000075
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-154-R31.8/R32.1
Work Description: CONSTRUCT CIDH CONCRETE PILES AND STRUCTURAL CONCRETE BRIDGE.
Location Description: SANTA BARBARA COUNTY IN AND NEAR SANTA BARBARA FROM PRIMAVERA ROAD UNDERCROSSING TO LA COLINA ROAD UNDERCROSSING
Contractor Name: CA Rasmussen
Contractor Address: 28548 LIVINGSTON AVENUE, VALENICA CA 91355
Resident Engineer: Jeffery Finn Structure Rep.: Emiliano Berntsen
DIME Sample ID: 2022-11-04-1
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 Assurance
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 11/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/04/2022
The quantity of what the sample constitutes: 78
A brief description of the sample: Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martinez Steel Fontana
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 378222
Hoop Manufacturer Lot Number(s): 14
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 4'-2"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Cascada
Welding Company: Martinez Steel Fontana
Coating Standards: Uncoated
Weld Type: Flash Welded
