Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993173 DEA: 042J88U4 EFIS: 0418000401
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29-38.9/42.9
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-10-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Steel Check Sample Plate
Sample Taken Date: 04/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2023
The quantity of what the sample constitutes: 1
A brief description of the sample: #4 Square Rebar
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
Heat Number(s): NA
Material Specification: N/A
Grade: NA
Thickness: .5"
Shape: Trapezoid
Metal Foundry Manufacturer (Mill): NA
Plate Dimension: 3" long .5" thick
