Sample Record for 2023-09-12-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993915 DEA: 040Y9704 EFIS: 0422000388
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL/SCL-101-47.89/47.89
Work Description: Repair of girder 5 and replacement of girder 10, both in Span 1.
Location Description:
Contractor Name: Bridgeway Civil Constructors, Inc (Alexander Newman)
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: Arif Khan Structure Rep.: Steve Gong
Sample Information
DIME Sample ID: 2023-09-12-18
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 TM5 - Couplers
Sample Taken Date: 09/12/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Lot 1
A brief description of the sample: #6 250L Barlock Couplers
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bridgeway Constructors
Material Information
Production or Authorization Testing: Authorization Testing
Service or Ultimate: Ultimate
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Manufacturer: Nucor
Coupler Manufacturer: Dayton Superior
Intermediate Assembler or Fabricator:
Rebar Size: #6
Coupler Model: D250L Bar Lock
Coating Standards: Uncoated
Shape of Rebar: Straight
Rebar Hoop Diameter:
Rebar Hoop Fabricator:
Coupler Component Heat/Lot Number(s): 191878
Rebar Heat Number(s): 350002924121
Rebar Size 2 :
Coupler Unique ID: SL-17-06
Test Results
