Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994326 DEA: 051C3604 EFIS: 0512000134
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-217-0.9/1.4
Work Description: REPLACE BRIDGE.
Location Description: SANTA BARBARA COUNTY NEAR GOLETA FROM 0.2 MILE EAST OF GOLETA SLOUGH BRIDGE TO 0.4 MILE EAST OF SAN JOSE CREEK BRIDGE
Contractor Name: MCM CONSTRUCTION
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Manny Yogarajah Structure Rep.: Alis Chhay
DIME Sample ID: 2023-08-28-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM4 - Prestressing Strand
Sample Taken Date: 08/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/15/2023
The quantity of what the sample constitutes: 1
A brief description of the sample: 0.6 L/R 7 wire strand
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sumiden Wire
Comments:
Reel/Coil/Pack Number(s): S336577-2-1
Number of Coils: 1
Group Number:
Strand Diameter: .6 in
Grade: 270
Strand Specification: ASTM A 882
Heat Number(s): S0508323
Mfg. Lot Number(s): S336577-2-1
Manufacturer(s): Sumiden
DIME Test ID: 2023-08-28-2-1
Test Method: ASTM A882-20: Standard Specification for Filled Epoxy-Coated Seven-Wire Prestressing Steel Strand (Withdrawn 2019) (Coating Adhesion)
Verified Date: 09/15/2023
Date Tested: 09/06/2023
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:
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Coating Adhesion Pass/Fail
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Pass
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