Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208967 DEA: 110223U4 EFIS: 1112000102
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5,89-R29.1/R30.5
Work Description: REPLACE AND WIDEN BRIDGE, RECONSTRUCT RAMPS AND INTERSECTION.
Location Description: SAN DIEGO COUNTY IN SAN DIEGO FROM 0.4 MILE SOUTH OF GENESEE AVENUE OVERCROSSING TO SORRENTO VIADUCT
Contractor Name: Flatiron
Contractor Address: 1770 LA COSTA MEADOWS DRIVE, SAN MARCOS CA 92078
Resident Engineer: Dave Pound Structure Rep.: Anh Ma
DIME Sample ID: 2016-05-20-9
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Quality Assurance
Type of Material: SMTL TM6 - Ductile Iron Cast Samples
Sample Taken Date: 05/20/2016
Date that the sample was received by the laboratory/organization performing the testing: 05/25/2016
The quantity of what the sample constitutes: 1
A brief description of the sample: Coupon Casting
From where was the sample collected: Distributor
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bremen Castins
Heat Number (s): 04226
Part Number (s): 68 27 216 246
Material Specification: A536
Grades: 65-45-12
Metal Foundry Manufacturer (Mill): Bremen
Prestressing Manufacturer: DSI
