Sample Record for 2023-05-12-7
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.4/R7.7
Work Description: Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description: 101 freeway in Summerland, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Luobao Cai Structure Rep.: Emiliano Berntsen
Sample Information
DIME Sample ID: 2023-05-12-7
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: 05/12/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 932
A brief description of the sample: Headed Bars
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Headed Reinforcement Corporation (HRC)
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 4128000
Head Manufacturer Lot Number(s): 100011762742
Rebar Size: #8
Headed Bar Model Name: HRC 120 T Heads
Size of Head: Full Size - 9x
Head Connection Type:
Head Shape: Rectanglar
Rebar Manufacturer: CMC Steel Arizona
Head Manufacturer: Nucor
Head Fabricator: Nucor
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-17-03
Test Results
