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: 2024-01-17-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Authorization
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 01/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 02/05/2024
The quantity of what the sample constitutes: 4 couplers
A brief description of the sample: Headed Bars with Lenton DR14s
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: nVent Erico
Production or Authorization Testing: Authorization Testing
Rebar Heat Number(s): 6023254
Head Manufacturer Lot Number(s): U0147 / M0141
Rebar Size: #9
Headed Bar Model Name: LU28TDR14
Size of Head: Full Size - 9x
Head Connection Type: Friction Weld
Head Shape: Circular
Rebar Manufacturer: CMC Steel Oklahoma
Head Manufacturer: nVent Erico Lenton
Head Fabricator: nVent Erico Lenton
Material Standard Code: ASTM A706
Headed Bar Unique ID: 9FW-18-01
