Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-09-29-1
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 TM5 - Threaded Bar
Sample Taken Date: 09/29/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1200 pc
A brief description of the sample: 1"-8 x 40" Gr.105
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Circle Corp
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A193
Threaded Bar Grade: 193
Threaded Bar Type:
Rebar Size:
Nut Specification for Threaded Bar: ASTM A563
System Manufacturer: Gerdua
Epoxy Coating Color: NA
Threaded Bar Application: Threaded Bar
Coating Standards: ASTM A153 galvanized
Bar Heat Number(s): 223766
Nut Heat Number(s): 58055206
Bar Lot Number:
Nut Lot Number: 38353-58055206
Coupler Heat Number(s):
Coupler Grade:
