Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214830 DEA: 043G6304 EFIS: 0412000409
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-4-SCl-9 -4.75/4.9
Work Description: Saratoga Creek Bridge Rehabilitation Project
Location Description: San Jose - Saratoga Creek
Contractor Name: Myers and Sons
Contractor Address: 4600 NORTHGATE BLVD, STE 100, SACRAMENTO, CA 95834
Resident Engineer: Arif Khan Structure Rep.: OANH BUI
DIME Sample ID: 2023-07-18-5
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: 07/18/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 308
A brief description of the sample: Ultimate Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC San Bernardino
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4129681
Hoop Manufacturer Lot Number(s): Lot 1 2 and 3
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #7
Diameter of Hoop: 2'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC Arizona
Welding Company: CMC Rebar San Bernardino
Coating Standards: Uncoated
Weld Type: Flash Welded
