Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214998 DEA: 044H0504 EFIS: 0413000080
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-12-25.8-33.3
Work Description: BRIDGE SCOUR MITIGATION
Location Description: SONOMA COUNTY NEAR SANTA ROSA AT SONOMA CREEK BRIDGE AND AT HOOKER CREEK BRIDGE
Contractor Name: Ghilotti Construction Co. (Nishit Prajapati)
Contractor Address: 246 Ghilloti Ave, Santa Rosa CA 95407
Resident Engineer: leonard brajnikoff Structure Rep.: Anthony tierra
DIME Sample ID: 2023-06-02-4
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 - Welded Hoops
Sample Taken Date: 06/02/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 398
A brief description of the sample: Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4126990
Hoop Manufacturer Lot Number(s): 15
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 1'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC
Welding Company: CMC Rebar San Bernardino
Coating Standards: Uncoated
Weld Type: Flash Welded
