Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215620 DEA: 01436404 EFIS: 0100000193
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-35.8/36.5
Work Description: Dr. Fine Bridge Replacement
Location Description: DR. FINE BRIDGE REPLACEMENT FROM LAKE EARL DR TO S FRED D. HAIGHT DR ON HWY 101 ACROSS SMITH RIVER.
Contractor Name: MCM Construction
Contractor Address: PO Box 620, North Highlands, Ca 95660
Resident Engineer: Clayton Malmberg Structure Rep.: Brian Cinkutis
DIME Sample ID: 2024-02-22-1
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 - Welded Hoops
Sample Taken Date: 02/22/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: Lots 1, 4, and 10
A brief description of the sample: #8 X 7'-0" Ultimate Welded Hoops Lot 1, 4, 10
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: T.N.T Rebar Company
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 3500035788 - 3500035789
Hoop Manufacturer Lot Number(s): Lots 1, 4, 10
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #8
Diameter of Hoop: 7'-0"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor Seattle
Welding Company: RKR Steel Welding
Coating Standards: Uncoated
Weld Type: Flash Welded
