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Sample Record for 2023-03-10-6

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Project Information

Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete

Sample Information

DIME Sample ID: 2023-03-10-6
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: 03/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/10/2023
The quantity of what the sample constitutes: 8 total #10 HRC 120 T-Heads
A brief description of the sample: #10 HRC 120 T-Head
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC Fountain Valley

Material Information

Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4124053
Head Manufacturer Lot Number(s): 100011821241
Rebar Size: #10
Headed Bar Model Name: HRC 120 T Heads
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Square
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: nucor cold finish utah
Head Fabricator: HRC Fountain Valley
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03

Test Results