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: 2024-03-26-67
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: Department Acceptance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 03/26/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/02/2024
The quantity of what the sample constitutes: 6
A brief description of the sample: 1.75" A722 Type II Threaded Bar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form
Production or Authorization Testing: Authorization Testing
Threaded Bar Specification: ASTM A722
Threaded Bar Grade: 150
Threaded Bar Type: Deformed
Rebar Size:
Nut Specification for Threaded Bar: A29
System Manufacturer: Williams Form
Epoxy Coating Color: NA
Threaded Bar Application:
Coating Standards: Uncoated
Bar Heat Number(s): 100891963
Nut Heat Number(s): 79008719
Bar Lot Number:
Nut Lot Number: 46S3D
Coupler Heat Number(s): 100104123
Coupler Grade:
