Sample Record

Owner Lab

  • CT HQ - Sacramento Materials Management Branch Field Office

DIME Sample ID 2019-11-13-20

Project Information

Project IdentifiersProject ID: 208973
DEA: 120H1004
EFIS: 1200000180
COOP: 120670
DIST-CO-RTE-PM12-ORA-405,73,405,605-9.3/24.3
Award Date11/07/2016
Closeout DateNot set
Work Description(Alternative Delivery) San Diego Freeway (I-405) Improvement Project SR-73 to I-605, Design Build Project, Administered by Orange County Transportation Authority, Caltrans METS to perform Source Inspection per RFP.
Location DescriptionOrange and Los Angeles Counties: 12-ORA-405 PM 9.3/24.2 / 07-LA-405 PM 0.0/1.2 12-ORA-22 PM R0.7/R3.8 / 12-ORA-22 PM R0.5/R0.7 12-ORA-73 PM R27.2/R27.8 / 12-ORA-605 PM 3.5/R1.6 07-LA-605 PM R0.0/R1.2
QA Service Level1 (Verified on 09/10/2015)

Sample Information

Sample Taken Date11/13/2019 Sample Unique Key20
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 testing11/14/2019
Sample typeQuality Assurance A brief description of the sample#5 T-Heads
The quantity of what the sample constitutes4 samples from Lot # 1 From where was the sample collectedFabricator
First name of sampler or witnessed byDaniel Last name of sampler or witnessed byReyes
Title of samplerCT METS QA INSPECTOR Telephone number of sampler(707) 656-9086
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameHeaded Reinforcement Corp, Fountain Valley, CA Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormB301-018-19 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingAuthorization Testing
Rebar Heat Number(s)4090965 Head Manufacturer Lot Number(s)B1128831
Rebar Size5 Headed Bar Model NameHRC 120
Size of HeadReduced Size - 4x Head Connection TypeFriction Weld
Head ShapeSquare Rebar ManufacturerCMC Etiwanda
Head ManufacturerNucor Head FabricatorHRC
Material Standard CodeASTM A706

Submitted Tests

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