Sample Record for 2023-05-18-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212720 DEA: 07291404 EFIS: 0712000094
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-55-58
Work Description: TRANCAS CREEK BRIDGE REPLACEMENT
Location Description: IN LOS ANGELES IN CITY OF MALIBU AT TRANCAS CREEK BRIDGE (53-0027).
Contractor Name: STACY AND WITBECK, INC.
Contractor Address: 3939 Atlantic Ave Suite 114, Long Beach, CA 90807
Resident Engineer: Gilbert Trujillo Structure Rep.: Frank Lofti
Sample Information
DIME Sample ID: 2023-05-18-2
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 - Couplers
Sample Taken Date: 05/18/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 216 pcs
A brief description of the sample: HRC 500 510 Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: HRC
Material Information
Production or Authorization Testing: Production Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC Steel
Coupler Manufacturer: HRC Fountian Valley CA
Intermediate Assembler or Fabricator:
Rebar Size: #10
Coupler Model: HRC 500 /510 XTender
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 74128926
Rebar Heat Number(s): 3120181, 4124054
Rebar Size 2 :
Coupler Unique ID: TP-17-03
Test Results
