Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994245 DEA: 051H4304 EFIS: 0516000073
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-21.4/21.9
Work Description: REPLACE STRUCTURAL CONCRETE BRIDGES.
Location Description: SANTA BARBARA COUNTY IN GOLETA FROM ROUTE 101/217 SEPARATION TO 0.3 MILE NORTH OF SAN JOSE CREEK BRIDGE
Contractor Name: MCM CONSTRUCTION
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Manny Yogarajah Structure Rep.: Fabian Velasco
DIME Sample ID: 2023-10-05-4
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 Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 10/05/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 10 Lots (1500 Hoops)
A brief description of the sample: #6 1'-6
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RKR Steel Welding
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 1202049061
Hoop Manufacturer Lot Number(s): Lots 32 thru 41
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 1'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor Utah
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
