Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209384 DEA: 04264094 EFIS: 0400000735 COOP: 042531
QA Service Level: 1
DIST-CO-RTE-PM: 04-,SON--
Work Description:
Location Description:
Contractor Name: GHILOTTI BROS / RM HARRIS JV
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Richard Duncan Structure Rep.: Brian Beaudoin
DIME Sample ID: 2016-09-29-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 09/29/2016
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 93
A brief description of the sample: Ultimate Butt Splice
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Harris Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): SE16100880
Hoop Manufacturer Lot Number(s): H18
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: 8
Diameter of Hoop: 5'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: Nucor
Welding Company: Harris Rebar
Coating Standards: Uncoated
Weld Type: Flash Welded
