Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995498 DEA: 072XL104 EFIS: 0724000158
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-14.23
Work Description: Column Casings Repair Work
Location Description:
Contractor Name: SECURITY PAVING COMPANY INC
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Sepand Minovi Structure Rep.: Suh Kwangsuk
DIME Sample ID: 2023-11-17-25
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Sample Organization Contact: (530) 329-6527
Type of Sample: Per Request
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 11/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/17/2023
The quantity of what the sample constitutes: 1 #11 bar, 2 #4 bars, 1 #5 bar
A brief description of the sample: Rebar from I-10 fire
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 53-1301
Structure name: Santa Monica Viaduct
The fabricator/manufacturer/facility name: Unknown
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): NA
Head Manufacturer Lot Number(s): No head
Rebar Size: #11
Headed Bar Model Name: No head
Size of Head: Full Size - 9x
Head Connection Type: Forged
Head Shape: Circular
Rebar Manufacturer: NA
Head Manufacturer: No head
Head Fabricator: No head
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FG-17-01
