Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2019-10-28-8

Project Information

Project IdentifiersProject ID: 212036
DEA: 044K2404
EFIS: 0417000284
DIST-CO-RTE-PM04-MRN,MRN-1-10.9, 10.8/10.9, 10.90, 6.6/10.9
Award Date01/31/2017
Closeout Date10/17/2022
Work DescriptionConstruct Solier Pile Wall
Location DescriptionNot set
QA Service Level1 (Verified on 03/17/2017)

Sample Information

Sample Taken Date10/28/2019 Sample Unique Key8
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 typeQuality Assurance A brief description of the sampleB7X Nuts for 38mm GDIA
The quantity of what the sample constitutes800 From where was the sample collectedManufacturer
First name of sampler or witnessed byBrian Last name of sampler or witnessed byMurray
Title of samplerQA Telephone number of sampler213 435 4055
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameWilliams Form Engineering Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL140-045-19 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Threaded Bar Production or Authorization TestingAuthorization Testing
Threaded Bar SpecificationASTM A513 Threaded Bar Grade513
Threaded Bar Type Rebar Size
Nut Specification for Threaded BarASTM A108 System ManufacturerWillaims Form Engineering
Epoxy Coating ColorNA Threaded Bar ApplicationSoil Nail
Coating StandardsASTM A123 galvanized Bar Heat Number(s)4173505 and 4124818
Nut Heat Number(s)8295752 Bar Lot NumberC21032757 and C21032856
Nut Lot Number Coupler Heat Number(s)M54421
Coupler Grade90

Submitted Tests

DIME Test IDTest MethodTester Name, Testing LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
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Test File Attachments