Sample Record

Owner Lab

  • CT QASI - Los Angeles Field Laboratory

DIME Sample ID 2017-05-05-3

Project Information

Project IdentifiersProject ID: 210569
DEA: 083555V4
EFIS: 0814000086
DIST-CO-RTE-PM08-SBD-15-42.5/46.0
Award Date11/05/2015
Closeout DateNot set
Work DescriptionWIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location DescriptionSAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
QA Service Level1 (Verified on 10/15/2015)

Sample Information

Sample Taken Date05/05/2017 Sample Unique Key3
Will the laboratory/organization for which you are a member perform testing on this material sample?No Date that the sample was received by the laboratory/organization performing the testingNot set
Sample typeAcceptance A brief description of the sampleTwo No. 9 grade 75 plain thread bar with two No. 9 grade 75 hex nuts
The quantity of what the sample constitutesUnknown From where was the sample collectedManufacturer
First name of sampler or witnessed byKen Last name of sampler or witnessed byVarela
Title of sampler Telephone number of sampler
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameWilliams Form Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifierNot set
Structure nameNot set

Material Information

Material TypeSMTL TM5 - Threaded Bar Production or Authorization TestingProduction Testing
Threaded Bar SpecificationASTM A615 Threaded Bar Grade75
Threaded Bar Type Rebar Size
Nut Specification for Threaded Barunknown System ManufacturerWilliams Form
Epoxy Coating ColorNA Threaded Bar Application
Coating StandardsUncoated Bar Heat Number(s)
Nut Heat Number(s) Bar Lot Number
Nut Lot Number Coupler Heat Number(s)
Coupler Grade

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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