Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2020-03-18-6

Project Information

Project IdentifiersProject ID: 214190
DEA: 024G41U4
EFIS: 0218000047
DIST-CO-RTE-PM02-SIS,SIS-5-Var
Award Date08/26/2019
Closeout Date11/24/2021
Work DescriptionREPLACE REINFORCED CONCRETE BRIDGES & CONSTRUCT RETAINING WALL.
Location DescriptionSHASTA AND SISKIYOU COUNTIES ABOUT 7 MILES NORTH OF POLLARD FLAT FROM 0.8 MILE SOUTH TO 0.7 MILE NORTH OF SIMS ROAD UNDERCROSSING AND FROM 0.6 MILE SOUTH OF CASTLE CRAGS DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF SOUTH DUNSMUIR UNDERCROSSING
QA Service Level1 (Verified on 07/09/2019)

Sample Information

Sample Taken Date03/18/2020 Sample Unique Key6
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 Control A brief description of the sample#8 Rebar with HRC 150 T Head
The quantity of what the sample constitutes48 From where was the sample collectedFabricator
First name of sampler or witnessed byChris Last name of sampler or witnessed byDsouza
Title of sampler Telephone number of sampler6469423585
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameHRC Fountain Valley Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Headed Bars Production or Authorization TestingProduction Testing
Rebar Heat Number(s)1202016630 Head Manufacturer Lot Number(s)Lot 1
Rebar Size8 Headed Bar Model NameHRC 150
Size of HeadFull Size - 9x Head Connection TypeFriction Weld
Head ShapeSquare Rebar ManufacturerNucor
Head ManufacturerHRC 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