Sample Record

Owner Lab

  • CT HQ - QASI Los Angeles Field Office

DIME Sample ID 2020-04-22-1

Project Information

Project IdentifiersProject ID: 214923
DEA: 081L7104
EFIS: 0820000141
DIST-CO-RTE-PM08-RIV-91-10.29
Award Date04/13/2020
Closeout Date01/14/2021
Work DescriptionBridge Repair
Location DescriptionNot set
QA Service Level1 (Verified on 04/21/2020)

Sample Information

Sample Taken Date04/22/2020 Sample Unique Key1
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 sampleXXXX
The quantity of what the sample constitutesXXXXX From where was the sample collectedFabricator
First name of sampler or witnessed byDavid Last name of sampler or witnessed byWeeks
Title of samplerASI Telephone number of sampler310-883-8369
Laboratory sample identification Linked DIME Sample ID
The fabricator/manufacturer/facility nameIntegrity Rebar Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) FormL79-015-20 Structure unique identifier
Structure nameXXXX

Material Information

Material TypeSMTL TM5 - Couplers Production or Authorization TestingAuthorization Testing
Service or UltimateService Material Standard CodeASTM A706
Material Grade60 Rebar ManufacturerXXXX
Coupler ManufacturerBarSplice Intermediate Assembler or FabricatorIntegrity Rebar
Rebar Size#5 Coupler ModelZap Screwlok Type 2
Coating StandardsUncoated Shape of RebarStraight
Rebar Hoop DiameterNA Rebar Hoop FabricatorNA
Coupler Component Heat/Lot Number(s)XXXX Rebar Heat Number(s)XXXX
Rebar Size 2 5 Coupler Unique IDNot set

Submitted Tests

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

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Test File Attachments