Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993856 DEA: 042J7304 EFIS: 0415000004
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-6.7/7.6
Work Description: SM 101 Cordilleras Crk Br Replacement
Location Description:
Contractor Name: Myers & Sons Construction
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Peter Lam Structure Rep.: Tyler Pinell
DIME Sample ID: 2023-09-11-10
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3674 - Pacifica 2
Sample Organization Contact: (510) 714-7639
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Couplers
Sample Taken Date: 09/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/12/2023
The quantity of what the sample constitutes: 8 sample splices representing 2 lots
A brief description of the sample: Splice test samples
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 35-0365
Structure name: Cordilleras Creek Bridge
The fabricator/manufacturer/facility name: Dayton Superior/CNC Rebar
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Service
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: CMC
Coupler Manufacturer: Dayton Superior
Intermediate Assembler or Fabricator:
Rebar Size: #4
Coupler Model: Bar-Lock D250L
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 192700, 4000003591
Rebar Heat Number(s): 4130965
Rebar Size 2 : 7
Coupler Unique ID: SL-17-06
