Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2019-07-09-3
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 212562 DEA: 024G5504 EFIS: 0214000036 |
|---|---|
| DIST-CO-RTE-PM | 02-SIS-5-2.7/R11.4 |
| Award Date | 03/12/2018 |
| Closeout Date | 10/05/2020 |
| Work Description | RECONSTRUCT WITH HMA AND PCC, WIDEN STRUCTURE AND UPGRADE RAILS |
| Location Description | SISKIYOU COUNTY IN AND NEAR DUNSMUIR FROM SACRAMENTO RIVER BRIDGE TO 0.6 MILE SOUTH OF NORTH MOUNT SHASTA UNDERPASS |
| QA Service Level | 1 (Verified on 04/04/2018) |
Sample Information
| Sample Taken Date | 07/09/2019 | Sample Unique Key | 3 |
|---|---|---|---|
| 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 testing | 07/09/2019 |
| Sample type | Verification | A brief description of the sample | 1-1/2" Dowel Bar Baskets |
| The quantity of what the sample constitutes | 76 | From where was the sample collected | Fabricator |
| First name of sampler or witnessed by | Kenneth | Last name of sampler or witnessed by | Varela |
| Title of sampler | Associate Steel Inspector | Telephone number of sampler | 562-440-7716 |
| Laboratory sample identification | Linked DIME Sample ID | ||
| The fabricator/manufacturer/facility name | Simplex JC Supply | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
| Structure name |
Material Information
| Material Type | SMTL TM7 - Epoxy Coated Dowels | Dowel Metal Heat Number | 1202014112 |
|---|---|---|---|
| Dowel Epoxy Batch Number | 8996028139 | Dowel Coating Specification | ASTM A934 |
| Dowel Size | 1.5 in | Dowel Coating Color | Purple |
| Dowel Manufacturer | Nucor Steel | Dowel Coater | Simplex JC Supply |
| Release Number | Unknown | Quality Assurance Code | Unknown |
| Rebar Size (#) | N/A |
Submitted Tests
| DIME Test ID | Test Method | Tester Name, Testing Lab | Date Tested | Submitted By | Verified? | Release Date | Test Comments | Actions |
|---|---|---|---|---|---|---|---|---|
| No results found. | ||||||||
Sample File Attachments
| File Name | Extension | Date Uploaded | Actions |
|---|---|---|---|
| No results found. | |||