Sample Record
Owner Lab
- CT HQ - QASI Los Angeles Field Office
DIME Sample ID 2020-03-19-2
Sample Details QR Code
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Project Information
| Project Identifiers | Project ID: 208973 DEA: 120H1004 EFIS: 1200000180 COOP: 120670 |
|---|---|
| DIST-CO-RTE-PM | 12-ORA-405,73,405,605-9.3/24.3 |
| Award Date | 11/07/2016 |
| Closeout Date | Not 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 Description | Orange 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 Level | 1 (Verified on 09/10/2015) |
Sample Information
| Sample Taken Date | 03/19/2020 | Sample Unique Key | 2 |
|---|---|---|---|
| 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 testing | Not set |
| Sample type | Verification | A brief description of the sample | 2-1/2" bar |
| The quantity of what the sample constitutes | Unknown | From where was the sample collected | Distributor |
| 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 | Williams Form Eng | Transportation Laboratory (TL) Number | |
| Inspector Lot Number from the Transportation Laboratory (TL) Form | L08-028-20 | Structure unique identifier | |
| Structure name |
Material Information
| Material Type | SMTL TM5 - Threaded Bar | Production or Authorization Testing | Production Testing |
|---|---|---|---|
| Threaded Bar Specification | ASTM A722 | Threaded Bar Grade | 150 |
| Threaded Bar Type | Plain | Rebar Size | |
| Nut Specification for Threaded Bar | Nuts provided to facilitate bar testing only | System Manufacturer | Williams Form Eng |
| Epoxy Coating Color | NA | Threaded Bar Application | |
| Coating Standards | Uncoated | Bar Heat Number(s) | 100897803 |
| Nut Heat Number(s) | Nuts provided to facilitate bar testing only | Bar Lot Number | |
| Nut Lot Number | Nuts provided to facilitate bar testing only | Coupler Heat Number(s) | N/A |
| Coupler Grade | 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. | |||