Sample Record
Owner Lab
- CT HQ - QASI Sacramento Field Office
DIME Sample ID 2020-06-30-3
Sample is locked from editing. info
Project Information
Project Identifiers | Project ID: 214511 DEA: 010E0004 EFIS: 0113000091 |
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DIST-CO-RTE-PM | 01-HUM-101-84.4/84.8 |
Award Date | 01/29/2020 |
Closeout Date | 11/22/2023 |
Work Description | BRIDGE RAIL REPLACEMENT. |
Location Description | HUMBOLDT COUNTY NEAR ARCATA FROM JACOBY CREEK BRIDGE TO GANNON SLOUGH BRIDGE |
QA Service Level | 1 (Verified on 11/13/2019) |
Sample Information
Sample Taken Date | 06/30/2020 | Sample Unique Key | 3 |
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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 testing | 06/30/2020 |
Sample type | Quality Assurance | A brief description of the sample | #5 Lenton Formsaver Coupler |
The quantity of what the sample constitutes | 2 lots of 4 formsaver assemblies | From where was the sample collected | Job Site |
First name of sampler or witnessed by | Jaime | Last name of sampler or witnessed by | Pierson |
Title of sampler | Telephone number of sampler | ||
Laboratory sample identification | Linked DIME Sample ID | ||
The fabricator/manufacturer/facility name | Con-Fab California Corporation | Transportation Laboratory (TL) Number | |
Inspector Lot Number from the Transportation Laboratory (TL) Form | Structure unique identifier | ||
Structure name |
Material Information
Material Type | SMTL TM5 - Couplers | Production or Authorization Testing | Production Testing |
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Service or Ultimate | Service | Material Standard Code | ASTM A706 |
Material Grade | 60 | Rebar Manufacturer | CMC |
Coupler Manufacturer | Erico | Intermediate Assembler or Fabricator | Unknown |
Rebar Size | #5 | Coupler Model | FS5FES |
Coating Standards | ASTM A775 epoxy | Shape of Rebar | Straight |
Rebar Hoop Diameter | Unknown | Rebar Hoop Fabricator | Unknown |
Coupler Component Heat/Lot Number(s) | 8298218 | Rebar Heat Number(s) | 6014006 |
Rebar Size 2 | Coupler Unique ID | Not set |
Submitted Tests
Sample File Attachments
File Name | Extension | Date Uploaded | Actions |
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No results found. |
Test File Attachments
DIME Test ID: 2020-06-30-3-1 CTM 670-December 2013 (Verified)
DIME Test ID: 2020-06-30-3-2 CTM 670-December 2013 (Verified)
DIME Test ID: 2020-06-30-3-3 CTM 670-December 2013 (Verified)