Sample Record for 2023-05-04-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214355 DEA: 120K0214 EFIS: 1214000096
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-12.4/14.5
Work Description: South County Improvement Project (Phase 1 - Avery/Crown Valley) PLACE HMA, INSTALL CONC PAVEMENT, RETAIN WALL, MODIFY ELECT SYS. | Add one lane btwn 73 & Oso PKWY
Location Description: ORANGE COUNTY IN SAN JUAN CAPISTRANO, LAGUNA HILLS, LAGUNA NIGUEL AND MISSION VIEJO FROM 0.5 MILE SOUTH OF AVERY PARKWAY UNDERCROSSING TO 0.8 MILE NORTH OF CROWN VALLEY PARKWAY OVERCROSSING
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 Cushing, Suite 200, Irvine, CA 92618
Resident Engineer: Kifah Ramadan Structure Rep.: Imad Karam
Sample Information
DIME Sample ID: 2023-05-04-4
TL Number from the TL Form:
Sample Submitted By Organization: CT METS QASI - Los Angeles Design Build Field Laboratory
Sample Organization Contact: (619) 204-7248
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 05/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/04/2023
The quantity of what the sample constitutes: 64 couplers
A brief description of the sample: #11 HRC 500/510 Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 55-1111
Structure name: Avery Parkway Bridge Deck
The fabricator/manufacturer/facility name: Integrity Rebar Placers
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Vinton
Coupler Manufacturer: HRC
Intermediate Assembler or Fabricator:
Rebar Size: #11
Coupler Model: HRC 500/510
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): HRC500 166491
HRC510 73126937
Rebar Heat Number(s): 2220540
Rebar Size 2 :
Coupler Unique ID: TP-17-03
Test Results
