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Sample Record for 2023-08-21-6

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212498 DEA: 021H5204 EFIS: 0217000009 QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-3,263-48.5/49.7 - 49.41
Work Description: Roadway Rehabilitation
Location Description: 02-Sis-3, 263-R46.8/R48.0, 49.07/49.41
Contractor Name: Myers-Shea JV
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Austin Henry Structure Rep.: Nicolas Jimenez

Sample Information

DIME Sample ID: 2023-08-21-6
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 Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 08/21/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2023
The quantity of what the sample constitutes: 295 pieces
A brief description of the sample: 1-1/4" x 18" loose dowel bars
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Highway - Simplex

Material Information

Dowel Metal Heat Number: 1201052636
Dowel Epoxy Batch Number: CH1932JJ CH2172HC
Dowel Coating Specification: ASTM A934
Dowel Size: 1.25 in
Dowel Coating Color: Purple
Dowel Manufacturer: Nucor
Dowel Coater: American Highway Simplex
Release Number:
Quality Assurance Code:
Rebar Size (#):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2023-08-21-6-1
Test Method: ASTM A884-19e20: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Epoxy Coating Thickness)
Verified Date: 08/28/2023
Date Tested: 08/23/2023
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 9.28
Second Bar Mean 11.68
Lower spec. limit LSL 7 mils
Upper spec. limit USL 40 mils
Total mean value 10.48
Total number of values less than LSL no data
Total number of values greater than USL no data

Test 2 of 2

DIME Test ID: 2023-08-21-6-2
Test Method: ASTM A884-19e20: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Verified Date: 08/28/2023
Date Tested: 08/23/2023
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 3
Holidays Per Linear Foot of Bar 0
Holiday Test Pass/Fail Pass