Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2019-05-03-2

Project Information

Project IdentifiersProject ID: 213469
DEA: 024C40V4
EFIS: 0218000125
DIST-CO-RTE-PM02-SHA-5-R3.8/R11.7
Award Date11/06/2018
Closeout DateNot set
Work DescriptionWIDEN TO 6 LANES, BRIDGE REPLACEMENT AND WIDENING AND ROADWAY REHAB
Location DescriptionSHASTA COUNTY IN AND NEAR ANDERSON FROM ROUTE 5/273 SEPARATION TO 0.4 MILE SOUTH OF CHURN CREEK ROAD OVERCROSSING
QA Service Level1 (Verified on 12/31/2018)

Sample Information

Sample Taken Date05/03/2019 Sample Unique Key2
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing05/03/2019
Sample typeQuality Control A brief description of the sample#6 T-Head bars
The quantity of what the sample constitutes10 lots From where was the sample collectedFabricator
First name of sampler or witnessed byHitesh Last name of sampler or witnessed byPatel
Title of samplerQuality Assurance Inspector Telephone number of sampler9168691602
Laboratory sample identification Linked DIME Sample IDN/A
The fabricator/manufacturer/facility nameHRC Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL131-076-19 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingAuthorization Testing
Rebar Heat Number(s)9000009 Head Manufacturer Lot Number(s)B1127341
Rebar Size6 Headed Bar Model NameHRC150
Size of HeadReduced Size - 4x Head Connection TypeFriction Weld
Head ShapeCircular Rebar ManufacturerCMC
Head ManufacturerNucor Head FabricatorHRC
Material Standard CodeASTM A615 Headed Bar Unique IDNot set

Submitted Tests

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

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Test File Attachments