Sample Record

Owner Lab

  • CT QASI - Los Angeles Field Laboratory

DIME Sample ID 2020-03-19-6

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 Date03/19/2020 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 typeVerification A brief description of the sample1-3/8" Threaded Bar w/ nuts
The quantity of what the sample constitutes2 bars 4 nuts From where was the sample collectedFabricator
First name of sampler or witnessed byNicholas Last name of sampler or witnessed byHoffmann
Title of samplerQA Inspector Telephone number of sampler5105429827
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameDSI Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL124-20-20 Structure unique identifier
Structure name

Material Information

Material TypeSMTL TM5 - Threaded Bar Production or Authorization TestingProduction Testing
Threaded Bar SpecificationASTM A722 Threaded Bar Grade150
Threaded Bar Type Rebar Size
Nut Specification for Threaded BarN/A System ManufacturerDSI
Epoxy Coating ColorNA Threaded Bar ApplicationThreaded Bar
Coating StandardsUncoated Bar Heat Number(s)6214955103
Nut Heat Number(s)71079534 Bar Lot NumberN/A
Nut Lot NumberN/A Coupler Heat Number(s)N/A
Coupler GradeN/A

Submitted Tests

DIME Test IDTest MethodTester NameTesting LabDate TestedSubmitted ByVerified?Release DateTest CommentsActions
No results found.